Behavioral Consultation for HIV+ Older Adults Prescribed Opioids for Chronic Pain

描述(申请人提供)：艾滋病毒人群正在老龄化，大约50%的艾滋病毒患者报告慢性疼痛。高达20%的人接受慢性阿片类药物治疗的处方，滥用这些药物很常见。因此，对慢性疼痛治疗存在双边不满：许多患者没有报告症状完全缓解，艾滋病毒初级保健提供者(HIV-PCP)对阿片类药物的滥用表示担忧。经常出现一个有问题的循环：具有更严重疼痛的艾滋病毒患者更有可能滥用阿片类药物，而PCP不愿开出足够剂量的止痛药，可能会导致患者通过滥用或使用非法药物来寻求止痛。此外，这种不满可能导致糟糕的患者-提供者联盟，这在艾滋病毒治疗和抗逆转录病毒坚持方面很重要。尽管有这些关切，但几乎没有研究过减少滥用处方阿片类药物的干预措施；没有专门为艾滋病毒患者制定的干预措施。该项目将开发一种协作性的、简短的行为咨询干预措施，针对艾滋病毒+老年患者滥用处方阿片类药物。这项干预措施名为CHOACOT(艾滋病毒+老年人慢性阿片类药物治疗咨询)，可能包括：1)行为健康顾问(BHC)和患者之间的三次会议，2)BHC和HIV-PCP之间的两次简短咨询，以及3)患者、BHC和HIV-PCP的联席会议。CHOACOT将基于初级保健行为咨询模式和行为治疗技术，包括激励性访谈和功能评估。为了实现我们的目标，我们将从迭代开放试验(n=10)开始开发CHOACOT。接下来，我们将进行CHOACOT与常规强化治疗的试点随机临床试验(n=30)。阿片类药物滥用将是主要的结果变量。患者-提供者关系的质量、疼痛、其他物质的问题使用、抗逆转录病毒依从性和心理社会功能将是次要结果。具体目标是：目标1.开发和完善CHOACOT，使其符合艾滋病毒控制和预防中心、六方会谈和参与者的可行性和可接受性标准；开发和现场测试CHOACOT BHC手册；1b.开发一种可靠的六六六人工依从性测量方法；制定和现场测试六六六培训和监督程序。目标2.完善研究程序(如同意和随机化程序、评估程序)，并在确定征聘目标目标的同时确定其可行性和参与者的接受度。这一系列工作可能导致将一种理论驱动和经验验证的短暂干预措施纳入艾滋病毒护理工作，对象是服用阿片类药物治疗慢性疼痛并担心阿片类药物滥用的老年艾滋病毒患者。

DESCRIPTION (provided by applicant): The HIV population is aging and approximately 50% of HIV patients report chronic pain. Up to 20% receive prescriptions for chronic opioid therapy, and misuse of these medications is common. There is thus bilateral dissatisfaction with chronic pain treatment: many patients do not report full symptom relief and HIV primary care providers (HIV-PCPs) express concern about opioid misuse. A problematic cycle frequently arises: HIV patients with more severe pain are more likely to misuse opioids, and PCPs' reluctance to prescribe adequate doses of analgesics may lead patients to seek pain relief by such misuse or by use of illicit drugs. Further, this dissatisfaction can lead to poor patient-provider alliance, which is important in HIV treatment and antiretroviral adherence. Despite these concerns, few interventions have been studied to decrease misuse of prescribed opioids; none have been developed specifically for HIV patients. This project will develop a collaborative, brief, behavioral consultation intervention targeting misuse of prescribed opioids in older HIV+ adults. The intervention, CHOACOT (Consultation for HIV+ Older Adults on Chronic Opioid Therapy), will likely consist of: 1) three meetings between the Behavioral Health Consultant (BHC) and the patient, 2) two brief consultations between the BHC and the HIV-PCP, and 3) a joint meeting of the patient, BHC, and HIV-PCP. CHOACOT will be based on the primary care behavioral consultation model and behavior therapy techniques including motivational interviewing and functional assessment. To achieve our aims, we will develop CHOACOT beginning with an iterative open trial (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) of CHOACOT versus enhanced Treatment-As-Usual. Opioid misuse will be the primary outcome variable. Quality of the patient-provider relationship, pain, problematic use of other substances, antiretroviral adherence, and psychosocial functioning will be secondary outcomes. The specific aims are: Aim 1. Develop and refine CHOACOT so that it meets standards of feasibility and acceptability for HIV PCPs, BHCs, and participants; 1a. To develop and field test a CHOACOT BHC manual; 1b. To develop a reliable measure of BHC manual adherence; 1c. To develop and field-test BHC training and supervision procedures. Aim 2. Refine research procedures (e.g., consent and randomization processes, assessment procedures), and establish their feasibility and acceptability to participants while confirming recruitment goal targets. This lineof work could lead to the incorporation into HIV care of a theoretically-driven and empirically- tested brief intervention for older HIV patients who are prescribed opioids for chronic pain and for whom there is concern about opioid misuse.