Integrated Behavioral Treatment for Chronic Pain/Drug Use in Older MSM with HIV

描述（由申请人提供）：在美国，男男性行为者（MSM）受艾滋病毒影响最严重，占每年所有新感染艾滋病毒的63%。有了高效的艾滋病药物和持续的艾滋病保健，这些男同性恋者活得更长了；据估计，到2015年，超过50%的美国艾滋病毒感染者年龄将在50岁或以上。越来越多的证据表明，慢性疼痛在老年艾滋病毒感染患者中普遍存在，并且可能与药物使用和滥用协同发生，这容易导致不参与和不坚持艾滋病毒护理、不坚持艾滋病毒药物治疗和性冒险。了解这些关系并将疼痛管理战略纳入卫生干预措施，将有助于制定量身定制的基于行为的综合干预措施，从而有可能改善疼痛管理，减少药物使用（和/或其对艾滋病毒疾病管理的干扰），并改善抗逆转录病毒治疗的依从性和参与护理设计。本应用程序的目的是：(1)通过从定性访谈中提取的患者生成主题，表征老年艾滋病毒感染的男男性行为者的慢性疼痛和物质使用/滥用；(2)通过定量综合评估，确定慢性疼痛、药物使用、HIV药物依从性和性风险之间的直接和中介关系；(3)通过公开试点，确定群体层面的综合行为干预的可行性和可接受性，以解决慢性疼痛和药物滥用问题，从而提高护理参与度和艾滋病毒药物依从性，并降低性风险。我们还将评估潜在的影响

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) in the US are most heavily affected by HIV, representing ~63% of all new HIV infections annually. With highly effective HIV medication and consistent engagement in HIV health care, these MSM are living longer; by 2015 it is estimated that more than 50% of Americans living with HIV will be 50 years of age or older. Evidence is emerging that chronic pain is prevalent in older HIV-infected patients and likely occurs synergistically with substance use and abuse, which predispose to non-engagement and non-retention in HIV care, non-adherence to HIV medications and sexual risk taking. Understanding these relationships and incorporating pain management strategies in health interventions will forge the development of a tailored behavioral-based, integrated intervention that has the potential to improve pain management, reduce substance use (and/or its interference in HIV disease management) and improve ART adherence and engagement in care Design. The aims of this application are to: (1) characterize chronic pain and substance use/abuse in older HIV-infected MSM, through patient generated themes extracted from qualitative interviews; (2) identify significant direct and mediated relationships between chronic pain, substance use, HIV medication adherence and sexual risk-taking, assessed via a quantitative comprehensive assessment battery; and, (3) determine the feasibility and acceptability of a group-level, integrated behavioral intervention to address chronic pain and substance abuse that could increase engagement in care and HIV medication adherence and decrease sexual risk taking, through an open pilot. We will also assess the potential for an effect examining pre-post differences on pain, substance use, HIV treatment, and sexual risk outcomes. To achieve these aims, self-generated emerging qualitative themes from 20 in-depth interviews will inform the development of a comprehensive, specifically tailored quantitative health assessment for 60 older HIV-infected MSM. The cross-sectional qualitative and quantitative data will specify a novel group-level, intervention to be piloted with 30 participants (6 groups of 5 men). These results will set the stage for a R34 RCT application to estimate controlled treatment effect sizes. This application is the first known attempt to investigate the behavioral processes involved in the association of chronic pain with substance use/abuse, engagement in care, HIV medication adherence and sexual risk taking among older MSM living with HIV. Furthermore, this is the first attempt to develop a group- level, integrated intervention specifically tailored to older HIV-infected MSM, an at-risk group who are disproportionately represented with HIV. These findings have the potential to change chronic pain and substance abuse treatment paradigms for older HIV-infected MSM and could improve engagement in care and decrease sexual risk taking.