Improving retention in care for persons with HIV who use substances by increasing acceptance and reducing stigma

项目概要/摘要 在美国，多达50%的艾滋病毒感染者（PWH）没有接受常规的艾滋病毒初级保健。 尤其是使用可卡因、甲基苯丙胺和阿片类药物的PWH。PWH 那些没有持续接受护理的人有以下风险：延迟抗逆转录病毒治疗（ART）的开始， 降低ART依从性、未抑制的病毒血症和死亡率。此外，不良的保留意味着有效的ART 不能用来防止艾滋病毒的进一步传播。长期目标是开发有影响力的，简短的 可以很容易地纳入通常的护理做法，以加强艾滋病毒护理保留的干预技术。 本提案是实现长期目标的下一步，其目的是调整和完善 在开放试验和小型随机对照试验的背景下，现有的保留干预措施。我们将 调整一个简短的，2个疗程的基于接受的行为治疗（ABBT）干预，以提高艾滋病毒的保留 通过针对耻辱来照顾使用药物的人。ABBT提倡对生活的接受态度， 挑战并鼓励参与者深思熟虑地披露血清状况和/或药物滥用 问题作为挑战污名化恐惧的行为步骤。核心假设是， 通过更多地接受艾滋病毒状况和物质，提高对污名化的容忍度 虐待行为，将增加威尔斯亲王医院的纵向承诺的照顾。 本建议的目的是：（1）使用迭代过程来完善ABBT的物质使用， 在讲英语者（n=7）和讲西班牙语的单语者（n=3）中进行公开试验，以照顾威尔斯亲王医院; （2）进行一项初步随机对照试验（n = 50;包括：10名西班牙语发言人）的ABBT与 治疗作为一种治疗（TAU）。主要结果将是保留护理。样本将包括60个艾滋病毒 至少9个月没有到我们的传染病诊所就诊的患者， 普罗维登斯这种方法是创新的，因为它通过使用简短的接受而脱离了现状- 通过远程保健提供的基于心理治疗的技术，以提高对艾滋病毒状况和物质的接受程度 滥用问题，并促进谨慎和周到的披露，作为支持保留的具体机制。 此外，ABBT将适应单语西班牙语的人，因为这批PWH需要更多 研究注意。在成功完成拟议的R34研究后，这项研究将有助于 重要的可操作的数据，将奠定基础的大规模调查ABBT的照顾 使用药物的PWH。

PROJECT SUMMARY/ABSTRACT As many as 50% of people with HIV (PWH) are not in regular HIV primary care in the U.S. This is particularly common for PWH who use substances such as cocaine, methamphetamines, and opioids. PWH who are not consistently retained in care are at risk for: delayed antiretroviral treatment (ART) initiation, reduced ART adherence, unsuppressed viremia, and mortality. Moreover, poor retention means effective ART cannot be leveraged to prevent further HIV transmission. The long-term goal is to develop impactful, brief intervention techniques that can be easily integrated into usual care practices to enhance HIV care retention. The objective of this proposal, which is the next step in attaining the long-term goal, is to adapt and refine an existing retention intervention in the context of an open trial and a small randomized controlled trial. We will adapt a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care for people who use substances by targeting stigma. ABBT promotes an accepting stance towards life’s challenges and encourages participants to thoughtfully disclose the serostatus and/or substance abuse problems as a behavioral step towards challenging stigmatization fears. The central hypothesis is that increased tolerance of stigmatization, facilitated through increased acceptance of HIV status and substance abuse behaviors, will increase PWH’s longitudinal commitment to care. The aims of this proposal are: (1) To use an iterative process to refine ABBT for substance using, out-of- care PWH by conducting an open trial in English-speakers (n=7) and monolingual Spanish speakers (n=3); and, (2) To conduct a pilot randomized controlled trial (n = 50; incl. 10 Spanish speakers) of ABBT vs. Treatment-as-Usual (TAU). Primary outcome will be retention in care. The sample will consist of 60 HIV patients who have not attended a medical visit in at least 9 months at our infectious diseases clinic in Providence, R.I. The approach is innovative in that it departs from the status quo by using brief acceptance- based psychotherapy techniques, delivered by telehealth, to increase acceptance of HIV status and substance abuse problems and promoting careful and thoughtful disclosure as a specific mechanism to support retention. Additionally, ABBT will be adapted for monolingual Spanish speakers as this cohort of PWH needs more research attention. Upon successful completion of the proposed R34 research, this study will contribute significant actionable data that will lay the groundwork for a large-scale investigation of ABBT for out-of-care PWH who use substances.