Adaptation of the Friendship Bench counseling intervention to improve mental health and HIV care engagement outcomes among people living with HIV who inject drugs in Vietnam

项目摘要 注射吸毒是东南亚艾滋病毒流行的主要驱动力。2017年，艾滋病毒感染率 在东南亚注射毒品的人中，这一比例为15%。PWID，其中大多数人使用阿片类药物 艾滋病患者的艾滋病毒检测率、护理保留率、抗逆转录病毒治疗（ART）启动率和病毒感染率都很低。 镇压艾滋病毒相关死亡率和全因死亡率也很高。常见精神 包括抑郁、焦虑和压力相关疾病在内的精神障碍（CMD）发生在40-50%的PLWH中， OUD与HIV患者的阴性结局密切相关，包括HIV病程恶化， 更快地进展为艾滋病，增加ART不依从性，并增加死亡率。 为了应对中低收入国家对精神卫生治疗的巨大需求，全球 精神卫生领域的重点是开发任务转移和整合方法， 专家提供大规模的循证心理健康干预措施。然而，这种任务转移 在东南亚的OUD中，解决CMD的干预措施受到的关注有限。越南，与 艾滋病毒携带者和开放式吸毒者的高流行率，美沙酮维持治疗与艾滋病毒护理的结合， 其优先发展CMD照顾这一人群，是一个理想的设置，以评估任务转移的心理 采取健康方法应对慢性病并改善艾滋病毒护理结果。 友谊长凳是一种可行有效的任务转移心理健康干预方法， 低资源环境是解决这一人群中CMD的有力候选者。FB是解决问题的 基于治疗的干预，在初级保健患者中治疗CMD的有效性得到证实， 由外行顾问提供外行辅导员可以通过OUD有效地向PLWH提供FB，但CMD可能 OUD患者更难治疗，需要经过专业培训的咨询师才能有效治疗。 我们在本提案中的目标是完成一项试验性随机试验，纳入来自4个MMT诊所的75名患者， 河内。我们的具体目标是：1）调整友谊实验室（FB）协议，以优化PLWH和 2）在一项三组单独随机试验中试用适应性FB，比较FB与 由非专业咨询师提供专业咨询，以加强对PLWH和OUD伴CMD的日常护理;以及 3)评估改编后的FB的可行性、保真度和可接受性，以及其初步指标 在改善CMD和参与艾滋病毒护理和药物使用治疗方面的影响。友谊长凳 这种方法有可能为解决CMD和减少HIV障碍做出重要贡献 艾滋病毒感染者中的治疗成功与OUD，一个关键的人口驱动艾滋病毒流行在越南和许多 东南亚国家该提案将为设计一个完全有效的临床 试验，以测试我们的适应FB协议在改善艾滋病毒，心理健康和药物使用治疗结果， 弱势群体。

PROJECT SUMMARY Injection drug use is the primary driver of the HIV epidemic in Southeast Asia. In 2017, the HIV prevalence among people who inject drugs (PWID) in Southeast Asia was 15%. PWID, most of whom have opiate use disorder (OUD), have low rates of HIV testing, retention in care, antiretroviral therapy (ART) initiation, and viral suppression. PWID also experience high rates of HIV-related and all-cause mortality. Common mental disorders (CMDs), including depressive, anxiety, and stress-related illnesses, occur in 40-50% of PLWH and OUD and are strongly associated with negative outcomes for HIV patients, including worsening course of HIV, more rapid progression to AIDS, increased ART non-adherence, and increased mortality rates. To respond to the great need for mental health treatment in low- and middle-income countries, the global mental health field has focused on developing task-shifting and integration approaches that equip non- specialists to deliver evidence-based mental health interventions at scale. However, such task shifting interventions to address CMDs have received limited attention in Southeast Asia among OUD. Vietnam, with its high prevalence of PLWH and OUD, its integration of methadone maintenance therapy with HIV care, and its priority for developing CMD care for this population, is an ideal setting to evaluate task-shifting mental health approaches to address CMDs and improve HIV care outcomes. The Friendship Bench (FB) is a feasible and effective task-shifting mental health intervention designed for low-resource settings that is a strong candidate to address CMDs in this population. FB is a problem solving therapy-based intervention with demonstrated effectiveness treating CMDs among primary care patients when delivered by lay counselors. Lay counselors may effectively deliver FB to PLWH with OUD, but CMD may prove more difficult to treat in patients with OUD and require professionally trained counselors to be effective. Our objective in this proposal is to complete a pilot randomized trial of 75 patients from 4 MMT clinics in Hanoi. Our specific aims are: 1) To adapt the Friendship Bench (FB) protocol to be optimized for PLWH and OUD in Vietnam; 2) To pilot the adapted FB in a three-arm individually randomized trial, comparing FB by professional counselors to FB by lay counselors to enhanced usual care for PLWH and OUD with CMDs; and 3) To assess the feasibility, fidelity, and acceptability of the adapted FB as well as preliminary indicators of its impact in improving CMD and engagement in HIV care and drug use treatment. The Friendship Bench approach has the potential to make an important contribution to address CMDs and reduce barriers to HIV treatment success among PLWH with OUD, a critical population driving the HIV epidemic in Vietnam and many Southeast Asian countries. This proposal will generate critical evidence for designing a fully powered clinical trial to test our adapted FB protocol in improving HIV, mental health, and drug use treatment outcomes for this vulnerable population.