Brief Acceptance and Commitment Therapy for HIV-Infected At-Risk Drinkers

针对感染艾滋病毒的高危饮酒者的简短接受和承诺疗法

• 批准号: 9883696
• 负责人: STEPHEN A MAISTO
• 金额: $ 21.37万
• 依托单位: SYRACUSE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-15 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9883696
• 关键词: AIDS prevention; Address; Adherence; Affect; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anxiety; Behavior Therapy; Behavioral; Biological; Biological Markers; Caring; Clinic; Clinical Trials; Cognitive Therapy; Continuity of Patient Care; Data; Drug usage; Failure; Feedback; Feeling; Focus Groups; Frequencies; Goals; HIV; HIV therapy; Heavy Drinking; Intervention; Interview; Length; Manuals; Measures; Mental Depression; Mental Health; Mental disorders; Meta-Analysis; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Preventive Intervention; Process; Provider; Publishing; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Schedule; Smoker; Smoking; Smoking Cessation Intervention; Telephone; Testing; Therapeutic Intervention; Thinking; Time; Treatment Efficacy; Treatment outcome; United States; Viral; Woman; active method; addiction; alcohol intervention; antiretroviral therapy; anxiety symptoms; anxiety treatment; behavioral health; binge drinking; brief alcohol intervention; chronic pain; comorbid depression; comorbidity; comparative effectiveness; comparative effectiveness trial; comparative efficacy; condoms; craving; depressive symptoms; drinking; evidence base; experience; improved; innovation; meetings; methamphetamine use; mindfulness; mortality risk; multidisciplinary; multidrug abuse; novel; opioid use; psychological symptom; reduce symptoms; reduced alcohol use; secondary analysis; secondary outcome; sexual risk behavior; skills; smoking cessation; success; successful intervention; transmission process; treatment adherence; treatment group

Abstract Alcohol consumption at hazardous levels is associated with negative consequences on nearly every step of the HIV care continuum. It is a critical factor in HIV treatment that, if unaddressed, significantly contributes to onward transmission and poor treatment outcomes. Alcohol interventions for people living with HIV (PLWH) in the United States (US) have shown mixed results, and no alcohol intervention for PLHW has shown long-term reductions in heavy drinking or a significant impact on HIV-related outcomes. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co- morbid mental health conditions, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, making it a promising approach for hazardous drinkers. The overall objective of this application is to adapt an existing brief ACT intervention developed for smoking cessation, and pilot test its feasibility and acceptability for PLWH who are hazardous drinkers. We hypothesize that the resulting intervention will be preliminarily associated with decreased alcohol use, improved ART adherence, decreased symptoms of depression, anxiety, and drug use, and increased acceptance—a known mechanism of change in ACT. The specific aims are as follows: Aim 1—we will adapt an existing brief ACT intervention for HIV-infected hazardous drinkers (ACT-AU). We will accomplish this aim by: Modifying a 5-session, telephone-delivered ACT intervention for smoking cessation via iterative multidisciplinary team meetings, focus group discussions with HIV clinic patients (N = 15-20), and qualitative interviews with HIV clinic providers (N = 5-10). Aim 2—we will conduct a pilot comparative effectiveness randomized clinical trial (RCT) of ACT-AU compared to a brief alcohol intervention previously shown to reduce drinking days among HIV-infected women. We will accomplish this aim by: Randomly assigning N = 74 HIV-infected hazardous drinkers (50% women) to the intervention developed in Aim 1, or a brief alcohol intervention similar in length and frequency of treatment sessions. We will assess feasibility, acceptability, and preliminary trial outcomes. Alcohol use and ART adherence will be assessed via both self-report and biomarkers at 6-weeks and 6-months post-randomization; preliminary changes in acceptance as well as symptoms of anxiety and depression, and drug use will also be examined 6- weeks and 3 and 6-months post-randomization. The proposed research will provide essential pilot data for a R01 application to conduct a full-scale RCT to determine the comparative efficacy of ACT-AU.

摘要 饮酒达到危险水平，几乎每一步都会产生负面影响。 艾滋病毒护理连续体。这是艾滋病毒治疗中的一个关键因素，如果不加以解决，它将极大地促进 继续传播和糟糕的治疗结果。年酒精对艾滋病毒携带者(PLWH)的干预 美国(US)的结果好坏参半，没有酒精干预对PLHW的影响是长期的 大量饮酒的减少或对艾滋病毒相关结果的重大影响。这是一个假设的原因 有限的成功是指这些干预措施未能解决多重重叠问题(例如，联合 危险饮酒者的病态心理健康状况、行为健康需求)。创新型 酒精干预策略可以对这些多重行为健康需求产生影响，在一种形式 在艾滋病毒护理方面能够可行地提供的服务是必要的。简短的接受和承诺 治疗(ACT)对感染艾滋病毒的危险饮酒者来说是一种很有前途的干预措施。ACT是一种跨诊断 使用正念技能和以价值观为导向的行为行动计划来影响广泛的 心理症状。ACT已显示出治疗焦虑、抑郁、慢性疼痛和 物质使用，使其成为危险饮酒者的一种有前途的方法。本应用程序的总体目标是 是调整现有的为戒烟而开发的短暂ACT干预措施，并试点测试其可行性和 对于危险饮酒者的PLWH可接受性。我们假设由此产生的干预将是 初步与减少酒精使用，改善抗逆转录病毒治疗的依从性，减少 抑郁、焦虑和药物使用，以及接受度的提高--这是ACT改变的一个已知机制。这个 具体目标如下：目标1-我们将调整现有的针对艾滋病毒感染者的简短ACT干预措施 危险饮酒者(ACT-AU)。我们将通过以下方式实现这一目标：修改5个会议的电话传递的ACT 通过迭代的多学科团队会议、焦点小组讨论进行戒烟干预 HIV门诊患者(N=15-20)，与HIV诊所提供者的定性访谈(N=5-10)。目标2-我们将 进行ACT-AU的试验性比较有效性随机临床试验(RCT)与简要的 此前有研究表明，酒精干预可以减少感染艾滋病毒的女性的饮酒天数。我们将完成 其目的是：将N=74名感染艾滋病毒的危险饮酒者(50%为女性)随机分配到干预组 在目标1中开发，或在治疗疗程的长度和频率上类似的简短酒精干预。我们 将评估可行性、可接受性和初步试验结果。饮酒和坚持艺术将是 在随机化后6周和6个月通过自我报告和生物标记物进行评估；初步 接受程度的变化以及焦虑和抑郁的症状，以及药物使用也将被检查6- 随机化后3个月和6个月。拟议的研究将为 应用R01进行全面随机对照试验，以确定ACT-AU的比较疗效。