Engaging HIV Patients in Primary Care by Promoting Acceptance

描述（由申请人提供）：艾滋病毒感染者面临的挑战包括长期、复杂的自我管理以及持续参与医疗保健。参与代表患者对护理的长期承诺，并使艾滋病毒/艾滋病感染者能够利用有效的医疗。然而，新接受治疗的患者往往会放弃治疗，或者无法保持定期的预约时间表。该提案的目标是探索和提高人们对艾滋病毒状况的接受程度，以此作为最大化参与的手段。基于接受的干预针对的是经验回避，或个人试图避免痛苦的内部和外部经历。对于艾滋病患者来说，这可能包括对即将到来的CD4实验室结果的焦虑或对因艾滋病毒诊断而在社区中被污名化的恐惧。根据我们之前对PLWHA的研究，以及在其他人群中为保持患者接受治疗而采取的基于接受性的干预措施，我们建议减少体验性回避将使PLWHA获得对血清状态的自我接受，并克服参与障碍。我们对基于接受和承诺治疗（ACT）的抗逆转录病毒依从性的简短接受性行为疗法（ABBT）的试点开发显示了在初级保健环境中的可行性和可接受性。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，由于各种原因（例如，药物副作用，shae等），艾滋病毒携带者的生活压力很大；我们建议，接受为艾滋病毒携带者卫生组织提供了一个框架，以容忍这些压力源，以优先考虑以价值为导向的方法从事医疗保健。本R34临床试验计划提案的目标是：(a)使ABBT适应由病例管理人员向不同的HIV+初级保健患者提供的以个体为基础的以接受为重点的两次会议干预；(b)采用迭代开放试验（n = 10），确定适应性干预的结构、内容可接受性和可行性；(c)在40名不同种族/种族的初级保健新患者中进行随机试点试验，以确定ABBT与常规治疗（TAU）对照条件相比的疗效，作为最终大规模（R01）的准备，具有相同的研究设计，有充分动力的随机临床试验；(d)检验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。这个项目的临床和公共卫生影响将是为初次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，增强患者对护理的长期承诺，使他们能够获得有效的医疗，延长生存期，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.