Brief Acceptance and Commitment Therapy for HIV-Infected At-Risk Drinkers Administrative Supplement

摘要 新冠肺炎疫情对美国人的心理健康和饮酒行为产生了重大影响 美国(美国)普通人口，并对艾滋病毒携带者(PLWH)造成了不成比例的影响。酒精 消费和压力都是艾滋病毒治疗中的关键因素，如果不加以解决，可能会显著 有助于继续传播和不良的治疗相关结果。饮酒干预对长春市白领健康人群的影响 美国则表现出喜忧参半的结果。这种有限成功的一个假设原因是这些项目的失败 解决多重重叠问题的干预措施(例如，共病心理健康状况、压力、 危险饮酒者的行为健康需求)。创新的酒精干预策略 可以对这些多重行为健康需求产生影响，其形式可以在 在艾滋病毒护理方面，尤其是在新冠肺炎大流行的背景下，需要这样做。简短的验收和 承诺疗法(ACT)对感染艾滋病毒的危险饮酒者来说是一种很有前途的干预措施。行为是一种 跨诊断治疗使用正念技能和价值观引导的行为行动计划来影响 一系列的心理症状。ACT已显示出对治疗焦虑、抑郁、慢性 疼痛和物质使用，因此对于危险饮酒者和应对措施的PLWH来说是一个有希望的方法 与新冠肺炎大流行相关的额外压力。我们提议扩大我们正在进行的NIAAA- 资助(R34AA026246)，通过申请通过电话提供的针对PLWH的ACT干预试点RCT 回应《关于压力管理的特别关注通知》的行政补充 新冠肺炎(非-AT-20-011)。此应用程序的总体目标是使用我们正在进行的 Pilot RCT(NCT0397406)，以收集公共卫生署在 新冠肺炎大流行，并确定随机对照试验的参与者是否认为我们的压力管理技术 ACT干预对COVID相关压力的管理是有用和适用的。具体目标如下 如下：目标1：将客观和自我报告的压力测量纳入试点随机对照试验。我们会 通过以下方式实现这一目标：增加一般和针对大流行的自我报告压力措施，以及自我报告 在所有研究访问中收集唾液皮质醇样本，包括新增加的12个月随访。目标2： 确定ACT作为电话压力管理干预措施的可行性和可接受性 在新冠肺炎大流行期间，PLWH。我们将通过修改我们的治疗手册来实现这一目标 纳入新冠肺炎相关应激，并根据治疗情况检查应激相关随机对照试验的结果。这 行政副刊将提供有关公共卫生部门与COVID相关的压力的重要信息，以及 提供有关电话传递的ACT用于压力管理的可行性和潜在有效性的数据。

Abstract The COVID-19 pandemic has had a significant impact on the mental health and alcohol use of the United States (US) general population, and has disproportionately affected people living with HIV (PLWH). Alcohol consumption and stress are both critical factors in HIV treatment that, if unaddressed, can significantly contribute to onward transmission and poor treatment-related outcomes. Alcohol interventions for PLWH in the US have shown mixed results. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co-morbid mental health conditions, stress, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed, especially in the context of the COVID-19 pandemic. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, and is thus a promising approach for PLWH who are hazardous drinkers and coping with additional stress related to the COVID-19 pandemic. We are proposing to expand our ongoing, NIAAA- funded (R34AA026246), pilot RCT of a telephone-delivered ACT intervention for PLWH by applying for an administrative supplement in response to the Notice of Special Interest on Stress Management in Relation to COVID-19 (NOT-AT-20-011). The overall objective of this application is to use the infrastructure of our ongoing pilot RCT (NCT0397406) to collect preliminary data on the level of stress experienced by PLWH during the COVID-19 pandemic, and to determine if participants in the RCT find the stress management techniques in our ACT intervention useful and applicable for the management of COVID-related stress. The specific aims are as follows: Aim 1: Incorporate objective and self-reported measures of stress into the pilot RCT. We will accomplish this aim by: adding general and pandemic-specific self-report measures of stress, and self- collected samples of salivary cortisol to all study visits, including a newly added 12-month follow-up. Aim 2: Determine the feasibility and acceptability of ACT as a telephone-based stress management intervention for PLWH during the COVID-19 pandemic. We will accomplish this aim by modifying our treatment manuals to incorporate COVID-19 related stress, and examining stress-related RCT outcomes by treatment condition. This administrative supplement will provide important information on COVID-related stress among PLWH, and provide data on the feasibility and potential efficacy of telephone-delivered ACT for stress management.