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.

项目摘要(摘要) 在美国艾滋病毒携带者中，有20%到40%的人患有抑郁症。 抑郁对护理的保留、抗逆转录病毒(ART)的坚持、持续的病毒抑制、 和生存。大多数患有抑郁障碍的艾滋病毒患者也有一个或多个共存 焦虑、创伤后应激障碍、酒精或药物使用障碍。这些共同发生的疾病 使抑郁症治疗复杂化，如果不加以治疗，将是艾滋病毒治疗的额外重要障碍。 全面解决艾滋病毒护理参与、抑郁症治疗的精神障碍 干预措施必须足够灵活，以解决这些精神疾病的共病。 抑郁症、焦虑症、创伤后应激障碍的标准药物和心理治疗干预 在HIV感染者中使用药物是有效的。然而，在多个领域培训干预者 用于多个诊断的方案是劳动密集型的，并导致治疗过程中的连接中断。作为替代方案， 跨诊断干预的最新进展提供了一个有希望的统一框架，全面 在加强艾滋病毒护理参与的同时，解决精神疾病的共病问题。跨诊断治疗 方法利用干预抑郁、焦虑、创伤后应激障碍和实质性疾病的共同要素 用于为出现任何组合的障碍的个人提供量身定制的综合治疗。 其中一种经过验证的跨诊断干预措施，即通用元素治疗方法，或称CETA，是 基于抑郁症、焦虑症、创伤后应激障碍等常见的认知行为疗法， 和物质使用障碍。CETA是由有监督的乐施会在低收入国家提供的 卫生工作者，并已证明在改善幸存者的抑郁、焦虑和创伤后应激障碍方面有效 在泰国和伊拉克的创伤；它还被进一步用于社区卫生推广，由国家 华盛顿。CETA以前没有针对艾滋病毒携带者或 特别是为了解决艾滋病毒护理参与问题。然而，CETA是这一目的的理想定位，因为 其治疗精神共病的统一方法，易于整合额外的认知行为 与艾滋病毒护理参与有关的内容，以及由非专家提供的设计。 我们建议根据美国接受艾滋病毒护理的成年人的特殊需求调整CETA，并试行 调整干预措施以评估可接受性、可行性、保真度和影响的初步迹象。我们 调整后的CETA干预将被患者和提供者接受的假设将被证明是可行的 整合到繁忙的艾滋病毒初级保健环境中，将保真度地提供，并将展示初步 在改善艾滋病毒和精神健康结果方面产生影响的迹象。这项提议将产生关键的 指导设计全面随机对照试验的证据，以测试调整后的CETA协议在 改善这一弱势群体的艾滋病毒治疗和心理健康结果。