Engaging HIV Patients in Primary Care by Promoting Acceptance

描述(申请人提供)：艾滋病毒携带者的挑战包括长期、复杂的自我管理以及持续的医疗护理。参与度代表患者对护理的纵向承诺，并允许艾滋病毒/艾滋病患者(PLWHA)利用有效的医疗治疗。然而，新来看病的患者往往会放弃看护，或者无法保持定期的预约时间表。这项建议的目标是探索和提高人们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一种手段。以接受为基础的干预措施以经验回避为目标，即个体试图避免痛苦的内部和外部经历。对于PLWHA来说，这可能包括对悬而未决的CD4实验室结果的焦虑，或者对一个人的社区因艾滋病毒诊断而受到羞辱的恐惧。根据我们之前与PLWHA的工作和基于接受的干预措施，使患者在其他人群中得到护理，我们建议减少经验回避将使PLWHA获得对血清状态的自我接受，并克服参与障碍。我们以接受和承诺疗法(ACT)为基础，初步开发了一种基于接受的行为疗法(ABBT)，用于抗逆转录病毒的依从性，在初级保健环境中显示了可行性和可接受性。然而，这项试验表明，任何药物依从性的改善都需要事先参与医疗服务，这是当前提案的重点。不可避免地，艾滋病毒携带者的生活因各种原因(例如，药物副作用、Shae等)而充满压力；我们建议接受为PLWHA提供一个框架，以容忍这些压力源，从而优先开展以价值为导向的医疗保健。R34临床试验计划提案的目标是：(A)使ABBT适应于两个疗程的、以个体接受为重点的干预措施，由病例经理向不同的HIV+初级保健患者提供；(B)使用迭代开放试验(n=10)，建立调整后干预措施的结构、内容可接受性和可行性；(C)对新接触初级保健的40名不同族裔/种族的患者进行随机试点试验，以确定ABBT相对于照常治疗(TAU)对照条件的疗效，为最终进行大规模(R01)、动力充足的随机临床试验做准备，采用相同的研究设计；以及(D)检查一种新的愿意向非性伴侣披露艾滋病毒状况的新措施的初步心理测量学特性。该项目的临床和公共卫生影响将是为新接触护理的艾滋病毒患者开发一种简单、低成本、可传播的干预措施，增强患者对护理的纵向承诺，从而使S/他能够获得有效的医疗，从而延长生存时间，提高生活质量。

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.