Brief Acceptance-Based Retention Intervention for Newly Diagnosed HIV Patients

项目总结/摘要 在与艾滋病毒护理挂钩后的头几个月，诊所的辍学率高达50%， 31-46%的患者在第一次就诊后退出。未感染艾滋病毒的艾滋病毒感染者 持续接受护理的患者面临以下风险：延迟抗逆转录病毒治疗（ART）开始，减少ART 粘附、未抑制的病毒血症和死亡率。此外，不良的保留意味着有效的ART不能被使用。 防止艾滋病毒进一步传播。长期目标是改善艾滋病毒护理级联， 制定具有广泛适用性的基于行为的干预措施，以最小的成本执行 以及在社区艾滋病护理医疗环境中的努力。这项提案的目标，也就是下一步 在实现长期目标和建立在我们成功的R34研究的基础上，是进行一个全面的， 一项随机对照试验（RCT），旨在评估一项简短的、2个疗程的基于接受的行为治疗的有效性。 ABBT干预措施，以提高艾滋病毒护理的保留率。核心假设是参与者的 向其支助系统的成员通报艾滋病毒状况， 在医疗护理早期接受艾滋病毒状况，将增加他们对护理的纵向承诺。 本提案的目的是：（1）在2组RCT中测试ABBT干预对以下患者的疗效： 保持护理和病毒学抑制（主要结局）;以及，抗逆转录病毒治疗依从性，披露艾滋病毒状况， 感知的社会支持，艾滋病毒污名化（次要结果），相对于加强治疗， （2）检查艾滋病毒护理和病毒抑制的保留程度， 通过（a）增加HIV接受（和减少HIV经验回避）和（B）增加 愿意透露艾滋病毒状况。该样本将包括270名艾滋病毒患者谁是新的照顾，招募 来自罗德岛州普罗维登斯两个地理和种族多样的大型艾滋病毒医疗机构，和新 洛杉矶奥尔良该方法的创新之处在于，它从现状出发，采用了基于简短接受的 通过面对面和电话提供心理治疗技术，以提高对艾滋病毒状况的接受程度， 促进仔细和周到的血清状态披露，作为支持保留的具体机制， 病毒学抑制在成功完成拟议的R 01研究后，本研究将有助于 重要的可操作数据阐明ABBT对医疗保健的影响和调解机制 保留和病毒学抑制。从而，为简单、低成本的传播打下基础 可以纳入常规艾滋病毒护理的干预措施。

Project Summary/Abstract Drop-out rates from medical clinics in the first months following linkage to HIV care are as high as 50%, with 31-46% of patients dropping out after the first visit. People Living with HIV (PLWH) who are not consistently retained in care are at risk for: delayed antiretroviral treatment (ART) initiation, reduced ART adherence, unsuppressed viremia, and mortality. Moreover, poor retention means effective ART cannot be leveraged to prevent further HIV transmission. The long-term goal is to improve the HIV care cascade by developing behaviorally-based interventions with broad applicability that can be executed with minimal cost and effort in community-based HIV care medical settings. The objective of this proposal, which is the next step in attaining the long-term goal and building on our successful R34 study, is to conduct a fully powered, randomized controlled trial (RCT) to assess the efficacy of a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care. The central hypothesis is that participants' informed disclosure of HIV status to members of their support system, facilitated through increased acceptance of HIV status early in medical care, will increase their longitudinal commitment to care. The aims of this proposal are: (1) To test, in a 2-arm RCT, the efficacy of the ABBT intervention on retention in care and virologic suppression (primary outcomes); and, ART adherence, disclosure of HIV status, perceived social support, HIV stigmatization (secondary outcomes), relative to an Enhanced-Treatment-as- Usual condition; and, (2) To examine the degree to which retention in HIV care and virologic suppression are mediated by (a) increased HIV acceptance (and decreased HIV experiential avoidance) and (b) increased willingness to disclose HIV status. The sample will consist of 270 HIV patients who are new to care, recruited from two large, geographically and ethnically diverse HIV medical care settings in Providence, R.I., and New Orleans, L.A. The approach is innovative in that it departs from the status quo by using brief acceptance-based psychotherapy techniques, delivered in-person and by telephone, to increase acceptance of HIV status and promoting careful and thoughtful serostatus disclosure as a specific mechanism to support retention and virologic suppression. Upon successful completion of the proposed R01 research, this study will contribute significant actionable data clarifying the impact and mediational mechanisms of ABBT on medical care retention and virologic suppression. Thus, it will lay the groundwork for the dissemination of a simple, low-cost intervention that can be integrated into usual HIV care.