Engaging HIV Patients in Primary Care by Promoting Acceptance

通过促进接受来让艾滋病毒患者参与初级保健

• 批准号: 8466640
• 负责人: Ethan Moitra
• 金额: $ 21.56万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-21 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8466640
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Adverse effects; Aftercare; Anti-Retroviral Agents; Anxiety; Appointments and Schedules; Attention; Behavior Therapy; Behavioral; Caring; Case Manager; Cessation of life; Clinic; Clinical; Clinical Trials; Cognition; Communities; Competence; Complex; Consent; Counseling; Development; Disclosure; Distress; Drops; Enrollment; Family; Frequencies; Friends; Fright; Goals; Guidelines; HIV; HIV Seropositivity; HIV diagnosis; Individual; Intervention; Life; Link; Measures; Mediating; Medical; Modeling; Outcome; Participant; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Plant Roots; Population; Preparation; Primary Health Care; Procedures; Process; Process Assessment; Professional counselor; Property; Psychometrics; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Research; Research Design; Risk; Sampling; Self Management; Services; Sexual Partners; Social support; Stigmatization; Structure; Techniques; Testing; Therapeutic Effect; Training Programs; Treatment Efficacy; Validity and Reliability; Visit; Work; base; brief intervention; care seeking; cost; experience; follow-up; improved; indium arsenide; medical appointment; medication compliance; novel; pilot trial; primary care setting; primary outcome; psychologic; public health relevance; response; secondary outcome; social stigma; stressor; transmission process; treatment as usual; willingness

DESCRIPTION (provided by applicant): The challenge of living with HIV involves long-term, complex self-management as well as consistent engagement in medical care. Engagement represents a patient's longitudinal commitment to care and permits People Living With HIV/AIDS (PLWHA) to take advantage of effective medical treatments. Yet too often patients new to care drop out of care or fail to maintain a regular appointment schedule. This proposal targets exploring and increasing acceptance of one's HIV status as a means to maximize engagement. Acceptance-based interventions target experiential avoidance, or an individual's attempts to avoid distressing internal and external experiences. For PLWHA, this might include anxiety about pending CD4 lab results or fear of stigmatization in one's community due to HIV diagnosis. Based on our prior work with PLWHA and acceptance-based interventions to keep patients in care in other populations, we suggest reductions in experiential avoidance will allow PLWHA to gain self-acceptance of serostatus and overcome engagement barriers. Our pilot development of a brief acceptance-based behavior therapy (ABBT) for antiretroviral adherence rooted in acceptance and commitment therapy (ACT), showed feasibility and acceptability in the primary care setting. However, this trial suggested that any improvement in medication adherence required prior engagement in medical services, the focus of the current proposal. Inevitably, life with HIV is stressful for a variety of reasons (e.g., medication side effects, shae, etc.); we suggest acceptance provides PLWHA with a framework to tolerate these stressors in the service of prioritizing a value-driven approach to engaging in medical care. The objectives of this R34 Clinical Trial Planning proposal are to (a) adapt ABBT to a two-session, individual-based acceptance-focused intervention to be delivered by case managers to diverse HIV+ primary care patients; (b) using an iterative open trial (n = 10), establish the structure, content acceptability, and feasibility of the adapted intervention; (c) conduct a randomized pilot trial ina sample of 40 ethnically/racially diverse patients who are new to primary care to establish the efficacy of ABBT in comparison to an treatment- as-usual (TAU) control condition, as preparation for an eventual large-scale (R01), adequately powered randomized clinical trial with the same research design; and, (d) examine preliminary psychometric properties of a novel measure of willingness to disclosure HIV status to non-sex partners. The clinical and public health impact of this project will be the development of a simple, low-cost, disseminable intervention for HIV patients new to care that enhances a patient's longitudinal commitment to care so s/he can obtain effective medical treatments that will prolong survival and improve quality of life.

描述（由申请人提供）：艾滋病毒感染者的挑战涉及长期，复杂的自我管理以及持续参与医疗护理。参与是病人对护理的长期承诺，使艾滋病毒/艾滋病感染者能够利用有效的医疗。然而，太多的情况下，新病人放弃护理或未能保持定期预约时间表。这项建议的目标是探索和提高对自己艾滋病毒状况的接受程度，以此作为最大限度地参与的手段。基于接受的干预措施针对的是经验性回避，或个人试图避免令人痛苦的内部和外部经历。对于艾滋病毒感染者，这可能包括对等待CD 4实验室结果的焦虑，或担心因艾滋病毒诊断而在社区中受到羞辱。根据我们先前对PLWHA的工作和基于接受的干预措施，以使患者在其他人群中得到护理，我们建议减少经验性回避将使PLWHA获得自我接受血清状态并克服参与障碍。 我们的试点发展的一个简短的接受为基础的行为疗法（ABBT）的抗逆转录病毒治疗依从性植根于接受和承诺治疗（ACT），在初级保健设置的可行性和可接受性。然而，这项试验表明，药物依从性的任何改善都需要事先参与医疗服务，这是目前提案的重点。不可避免的是，艾滋病毒感染者的生活因各种原因而充满压力（例如，药物副作用，shae等）;我们建议接受为PLWHA提供了一个框架，以容忍这些压力源，优先考虑价值驱动的方法来从事医疗保健服务。 本R34临床试验计划提案的目的是：（a）将ABBT调整为两个疗程，由病例管理者向不同的HIV+初级保健患者提供基于个体的以接受为中心的干预;（B）使用迭代开放试验（n = 10），确定调整后干预的结构、内容可接受性和可行性;（c）在40名种族/人种不同的初入初级保健的患者样本中进行一项随机试验，以确定ABBT与常规治疗（TAU）对照条件相比的疗效，为最终的大规模（R 01）做准备，具有相同研究设计的充分把握度的随机临床试验;以及（d）检查向非性伴侣披露艾滋病毒状况意愿的新措施的初步心理测量特性。 该项目的临床和公共卫生影响将是为刚接受护理的艾滋病毒患者开发一种简单、低成本、可推广的干预措施，增强患者对护理的纵向承诺，使其能够获得有效的医疗，延长生存期，提高生活质量。