Feasibility of the Mindfulness-Based Stress Reduction Intervention for BlackWomen Living with HIV

项目摘要/摘要 艾滋病毒携带者(PLWH)患轻度认知障碍(MCI)的可能性是未感染艾滋病毒的人的七倍。艾滋病毒携带者(WLWH)，更具体地说，非裔美国人(AA)WLWH，与感染艾滋病毒的男性同行和未感染艾滋病毒的妇女相比，认知功能较差。很少有研究针对这一人群采用非药物策略来缓解认知障碍。目前这项拟议的研究将评估基于正念的压力减轻(MBSR)在患有MCI的AA WLWH中的可行性和可接受性。MBSR有可能通过自我调节注意力和对应激事件的意识来减轻压力。MBSR在改善或稳定一般人群的认知、改善压力管理、心理困扰、身体和心理症状、生活质量和应对方面以及在PLWH中的ART依从性方面显示出有效性。然而，这些研究是在主要是白人和男性患者群体中进行的。因此，这里提出的研究将开始通过在MCI的情况下对AA WLWH进行MBSR干预来解决这些差距。这将是在具有MCI的AA WLWH中开发和实施MBSR协议的重要第一步。在我们的补充目标中，我们将在30名AA WLWH(15名/ARM)中进行适应性干预的双臂随机试点试验，并与常规护理对照组进行比较，以评估MBSR在患有MCI的WLWH中的可行性和可接受性。可行性将通过我们的能力来评估：(1)招募、随机和留住参与者，(2)根据手册提供干预，以及(3)参与者遵守家庭实践和任务。可接受性将通过定性数据(焦点小组关于参与者对干预的满意度和继续使用实践的意图的意见)以及定量数据(满意度调查)进行评估。这项研究的最终目标是：1)减少认知障碍和痴呆症患病率中的种族和性别差异；2)为下一步的疗效测试提供信息，并实施针对不同人群认知结果的基于群体的非药物干预措施；以及3)影响维持老龄人口认知健康的临床和公共卫生建议。

Project Summary/Abstract People living with HIV (PLWH) are seven times more likely to have mild cognitive impairment (MCI) than people without HIV. Women living with HIV (WLWH), and more specifically African American (AA) WLWH, have evidenced poorer cognitive function when compared to their male counterparts living with HIV and women without HIV. Few studies have targeted this population in non-pharmacological strategies to mitigate cognitive impairment. The current proposed study will assess the feasibility and acceptability of mindfulness-based stress reduction (MBSR) in AA WLWH with MCI. MBSR has the potential to reduce stress through self-regulation of attention and awareness to stressful events. MBSR has demonstrated efficacy in improving or stabilizing cognition, improving stress management, psychological distress, physical and psychological symptoms, quality of life, and coping in the general population, as well as ART adherence in PLWH. Yet, the studies have been conducted in predominately white and male patient populations. Thus, the research proposed here will begin to address these gaps by piloting the MBSR intervention for AA WLWH with MCI. This will be an important first step in developing and implementing MBSR protocols in AA WLWH with MCI. In our Supplement Aim we will conduct a two-arm randomized pilot test of the adapted intervention compared to a usual care control group among 30 AA WLWH (15/arm) to assess the feasibility and acceptability of the MBSR among WLWH with MCI. Feasibility will be assessed by our ability to (1) recruit, randomize, and retain participants and (2) deliver the intervention per the manual, as well as (3) participants adherence to home practices and assignments. Acceptability will be assessed via qualitative data (focus group input regarding participants’ satisfaction with the intervention and intent to continue using the practices), as well quantitative data (satisfaction survey). The ultimate goal of this research is to: 1) reduce racial and gender disparities in cognitive impairment and dementia prevalence, 2) inform next steps for efficacy testing and implementation of a group-based non-pharmacologic interventions targeting cognitive outcomes in diverse populations, and 3) impact clinical and public health recommendations for maintaining cognitive health in aging populations.