Tailored Response to Psychiatric Comorbidity to Improve HIV Care Engagement in the United States (TRACE)

针对精神合并症的定制应对措施以改善美国的艾滋病毒护理参与度 (TRACE)

• 批准号: 9926639
• 负责人: Brian W Pence
• 金额: $ 21.46万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926639
• 关键词: Address; Adherence; Adopted; Adult; Affect; Alcohol consumption; Alcohol or Other Drugs use; Anti-Retroviral Agents; Anxiety; Behavioral; Caring; Clinic; Clinical; Cognitive; Cognitive Therapy; Community Health; Comorbidity; Depressive disorder; Diagnosis; Disease; Effectiveness; Elements; General Population; Goals; HIV; Health; High Prevalence; Individual; Intervention; Iraq; Left; Mental Depression; Mental Health; Mental disorders; Outcome; Patients; Pharmacology; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Provider; Psychiatrist; Psychologist; Research; Resources; Social Workers; Substance Use Disorder; Supervision; Survivors; Testing; Thailand; Time; Training; Trauma; Treatment Failure; United States; Viral; Vulnerable Populations; Washington; antiretroviral therapy; arm; base; depressive symptoms; design; dual diagnosis; flexibility; improved; low income country; medication compliance; mortality; negative affect; post-traumatic stress; primary care setting; programs; randomized trial; response; scale up; secondary outcome; service providers; success; therapy design

PROJECT SUMMARY (ABSTRACT) Among adults living with HIV in the United States, between 20% and 40% are affected by depression. Depression negatively affects retention in care, antiretroviral (ART) adherence, sustained viral suppression, and survival. The majority of HIV patients with a depressive disorder also have one or more co-existing anxiety, post-traumatic stress, alcohol, or substance use disorders. These co-occurring disorders both complicate depression treatment and, if left untreated, represent additional important barriers to HIV treatment. To comprehensively address the psychiatric barriers to HIV care engagement, depression treatment interventions must be flexible enough to also address these psychiatric comorbidities. Standard pharmacological and psychotherapeutic interventions for depression, anxiety, PTSD, and substance use are effective among people with HIV.36-40 However, training interventionists in multiple protocols for multiple diagnoses is labor-intensive and leads to disconnects in treatment. As an alternative, recent advances in transdiagnostic interventions offer a promising unified framework for comprehensively addressing psychiatric comorbidity while enhancing HIV care engagement. Transdiagnostic treatment approaches capitalize on the common elements in interventions for depression, anxiety, PTSD, and substance use to offer tailored, integrated treatment to individuals presenting with any combination of the disorders. One such proven transdiagnostic intervention, the Common Elements Treatment Approach, or CETA, is based on the elements of cognitive behavioral therapy common to treatments for depression, anxiety, PTSD, and substance use disorders. CETA was developed to be delivered in low-income countries by supervised lay health workers, and has demonstrated efficacy in improving depression, anxiety, and PTSD among survivors of trauma in Thailand and Iraq; it has further been adopted for community health roll-out by the state of Washington. CETA has not previously been adapted for the particular needs of people living with HIV or specifically to address HIV care engagement. However, CETA is ideally positioned for this purpose because of its unified approach to treating psychiatric comorbidity, the ease of integrating additional cognitive behavioral content relating to HIV care engagement, and its design for delivery by non-specialists. We propose to adapt CETA for the particular needs of adults receiving HIV care in the US and pilot-test the adapted intervention to assess acceptability, feasibility, fidelity, and preliminary indications of impact. We hypothesize that the adapted CETA intervention will be acceptable to patients and providers, will prove feasible to integrate in a busy HIV primary care setting, will be delivered with fidelity, and will demonstrate preliminary indications of impact in improving HIV and mental health outcomes. This proposal will generate critical evidence to guide the design of a full-scale RCT to test the effectiveness of the adapted CETA protocol in improving HIV treatment and mental health outcomes for this vulnerable population.

项目总结（摘要）