权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

针对老年 HIV 感染男男性行为者的慢性疼痛/药物使用的综合行为治疗

基本信息

批准号：
9000143
负责人：
Conall Michael O'Cleirigh
金额：
$ 17.57万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9000143
关键词：
Address Adherence Affect Age-Years Aging Alcohol or Other Drugs use American Behavior Behavior Therapy Behavioral Caring Centers for Disease Control and Prevention (U.S.)Characteristics Comorbidity Data Development Disease Management Drug usage Elderly Epidemic HIV HIV Infections Health Health Benefit Healthcare Intervention Interview Life Literature Longevity Mediating Mental Health Methodology Modeling Neurofibromin 2 Outcome Pain Pain management Participant Patients Persons Pharmaceutical Preparations Play Population Process Public Health Quality of life Randomized Clinical Trials Reporting Research Risk Role Sampling Secondary Prevention Specific qualifier value Staging Substance abuse problem Testing Viral Load result base chronic pain design follow-up forging improved insight medication compliance men men who have sex with men novel reduced substance use response sex sexual risk taking substance abuse treatment therapy development transmission process treatment effect treatment strategy

项目摘要

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.

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，占每年所有新发艾滋病毒感染的63%。随着高效的艾滋病毒药物治疗和对艾滋病毒卫生保健的持续参与，这些男男性行为者的寿命更长;据估计，到2015年，超过50%的美国艾滋病毒感染者将达到50岁或以上。有证据表明，慢性疼痛在感染艾滋病毒的老年患者中普遍存在，并可能与药物使用和滥用协同发生，这使他们容易不参与和不继续接受艾滋病毒护理，不坚持使用艾滋病毒药物和进行性冒险。了解这些关系并将疼痛管理策略纳入健康干预措施将有助于开发一种基于行为的定制综合干预措施，这种干预措施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ART依从性和参与护理设计。本应用的目的是：（1）通过从定性访谈中提取的患者生成的主题，描述老年HIV感染的MSM中的慢性疼痛和物质使用/滥用的特征;（2）通过定量综合评估电池评估，确定慢性疼痛、物质使用、HIV药物依从性和性冒险之间的重要直接和中介关系;以及（3）通过一个开放的试点项目，确定一个群体水平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，从而增加对护理的参与和艾滋病毒药物治疗的依从性，并减少性风险。我们还将评估潜在的影响检查疼痛，物质使用，艾滋病毒治疗和性风险结果的前后差异。为了实现这些目标，自我生成的新兴定性主题从20个深入的访谈将告知发展的一个全面的，专门定制的定量健康评估60老年艾滋病毒感染的男男性行为者。横断面定性和定量数据将指定一个新的组级干预，将与30名参与者进行试点（6组，每组5人）。这些结果将为R34 RCT应用奠定基础，以估计受控治疗效应量。该应用程序是第一个已知的尝试，以调查慢性疼痛与物质使用/滥用，参与护理，艾滋病毒药物依从性和老年男男性行为者感染艾滋病毒的性风险之间的关联所涉及的行为过程。此外，这是第一次尝试发展一个群体水平的综合干预特别针对感染艾滋病毒的老年男男性行为者，这是一个高危群体，感染艾滋病毒的比例过高。这些发现有可能改变慢性疼痛和药物滥用治疗模式的老年艾滋病毒感染的男男性行为者，并可以提高参与护理和减少性风险。