Targeting HIV Retention and Improved Viral load through Engagement ('THRIVE')

总结/摘要： 艾滋病毒初级保健的保留率低导致艾滋病毒抑制率低，艾滋病毒感染率高 艾滋病毒/艾滋病的传播，并加剧了健康结果，包括生存方面的种族和民族差异。到目前为止， 没有干预措施，有效地重新联系和保留照顾，当他们被发现以外的艾滋病毒 诊所许多艾滋病毒感染者因危及生命但可预防的疾病住院治疗， 艾滋病毒感染治疗不当的并发症。他们是最重要的患者之一， 在乎我们先前的研究显示，在失医及住院的威尔斯亲王医院病人中， 应对、耻辱和心理健康困难几乎普遍存在。此外，回避应对是一种 出院后无法重新参与护理的预测因素。接受和承诺疗法（ACT）是一种 跨诊断干预，有能力解决一系列心理和行为相关的 PWH遇到的问题。ACT帮助患者克服回避，特别是避免 不舒服的内部状态和触发这种状态的情况， 应对和重新参与有意义和有价值的生活活动。短期ACT干预似乎 可行的，可接受的，至少初步有效。我们建议制定、完善和试行 对住院、非护理的PWH进行短暂（4-5小时）ACT干预。“针对艾滋病毒滞留和 通过参与改善病毒载量“（”繁荣“）将旨在帮助患者克服回避， 适应不良的应对策略涉及一系列问题，包括抑郁，焦虑，物质 虐待和与艾滋病毒有关的自我耻辱，所有这些都构成了护理的障碍。在全球范围内实现繁荣 出院后有电话助推器会议的医院将增加治疗的开始和完成， 这往往是威尔斯亲王医院未能有效提供精神健康服务的最大障碍。在目标1中， 一个简短的基于医院的transdiagnosis，个别交付的ACT干预（THRIVE）专门定制 为非护理住院的威尔斯亲王医院发展。来自多学科专家护理团队的意见 将利用提供者和PHW来创建治疗师协议和患者工作簿。我们将驾驶 在10名住院的非护理威尔斯亲王医院中茁壮成长，他们将对干预措施提供定性反馈。的 沿着来自患者和多学科团队的反馈，将用于完善THRIVE。在 目标2，我们将对改良的THRIVE干预（N=35）进行初步随机临床试验（RCT） 与常规治疗相比（N=35）。该试验性RCT将1）评价全面- 规模随机对照试验; 2）检查确定性随机对照试验关注结果的趋势。然后我们就可以 提交一份单独的授权，以测试在一项完全有效的随机试验中THRIVE的疗效。这项工作 减少艾滋病毒发病率和种族/民族差异，并有助于消除艾滋病毒/艾滋病的潜力 这是美国国家卫生研究院的优先事项。

Summary/ abstract: Poor retention in HIV primary care results in lower rates of HIV viral suppression, higher rates of HIV transmission, and exacerbates racial and ethnic disparities in health outcomes, including survival. To date, there are no interventions that effectively relink and retain PWH in care when they are found outside the HIV clinic. Many persons with HIV infection (PWH) are hospitalized with life-threatening but preventable complications of inadequately treated HIV infection. They are among the most important patients to retain in care. Our previous research shows that among PWH who are out of care and hospitalized, avoidance coping, stigma, and mental health difficulties were nearly universal. Further, avoidance coping was a predictor of failure to re-engage in care after discharge. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention with the capacity to address a range of psychosocial and behavior-related issues that PWH experience. ACT helps patients overcome avoidance, particularly avoidance of uncomfortable internal states and the situations that trigger such states, by promoting acceptance-based coping and re-engagement in meaningful and valued-life activities. Brief ACT interventions appear to be feasible, acceptable, and at least preliminarily, have efficacy. We propose to develop, refine, and pilot a brief (4-5 contact hours) ACT intervention for hospitalized, out-of-care PWH. `Targeting HIV Retention and Improved Viral load through Engagement' (`THRIVE') will aim to help patients overcome avoidance, a maladaptive coping strategy implicated in a range of problems, including depression, anxiety, substance abuse, and HIV-related self-stigma, all of which constitute barriers to care. Delivering THRIVE in the hospital with a phone booster session after discharge will increase therapy initiation and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services for PWH. In Aim 1, a brief hospital-based transdiagnostic, individually delivered ACT intervention (THRIVE) tailored specifically for out-of-care hospitalized PWH will be developed. Input from a multi-disciplinary team of expert care providers and PHW will be utilized to create the therapist protocol and patient workbook. We will then pilot THRIVE in 10 hospitalized out-of-care PWH who will provide qualitative feedback on the intervention. The feedback, along with input from patients and the multi-disciplinary team, will be used to refine THRIVE. In Aim 2, we will conduct a pilot randomized clinical trial (RCT) of the refined THRIVE intervention (N=35) compared to treatment as usual (N=35). This pilot RCT will 1) evaluate feasibility and acceptability for a full- scale RCT; and 2) examine trends in outcomes of interest for the definitive RCT. We will then be positioned to submit a separate grant to test the efficacy of THRIVE in a fully powered randomized trial. This work has the potential to decrease HIV morbidity and racial/ethnic disparities and contribute to ending the HIV epidemic in the United States, which are NIH priorities.