Improving retention in care for persons with HIV who use substances by increasing acceptance and reducing stigma

项目摘要/摘要 在美国，多达50%的艾滋病毒携带者(PWH)没有得到常规的艾滋病毒初级保健。这是 对于使用可卡因、甲基苯丙胺和阿片类药物等物质的PWH患者尤其常见。威尔斯亲王医院 那些没有持续接受护理的人面临以下风险：延迟抗逆转录病毒治疗(ART)启动， 减少抗逆转录病毒治疗的依从性、不受抑制的病毒血症和死亡率。此外，保留力差意味着有效的ART 不能被用来防止艾滋病毒的进一步传播。长期目标是开发有影响力的、简短的 可轻松整合到常规护理实践中的干预技术，以加强艾滋病毒护理的保留。 这项建议的目标是调整和完善一个 开放试验和小型随机对照试验背景下的现有保留干预。我们会 采用短暂的、基于接受的行为疗法(ABBT)干预，以增强HIV病毒的滞留 通过针对污名来照顾使用药物的人。ABBT促进对生活的接受立场 挑战并鼓励参与者慎重地披露血清状态和/或药物滥用 问题，作为挑战污名化恐惧的行为步骤。中心假设是 通过更多地接受艾滋病毒状况和物质，提高了对污名化的容忍度 虐待行为，将增加威尔斯亲王对护理的纵向承诺。 这项建议的目的是：(1)使用迭代过程来精炼ABBT，以供物质使用、非物质使用 护理威斯康星医院，在讲英语的人(n=7)和说单一西班牙语的人(n=3)中进行公开试验； 和，(2)进行试点随机对照试验(n=50；包括10位讲西班牙语的人)ABBT与 照常治疗(TAU)。主要结果将是保留在护理中。样本将包括60个艾滋病毒 已至少9个月没有到本院传染病诊所就诊的病人 罗德岛州普罗维登斯。这种方法是创新的，因为它通过使用简短的接受来偏离现状- 通过远程保健提供的基于心理治疗的技术，以增加对艾滋病毒状况和实质的接受 此外，该委员会还将继续努力解决滥用问题，并促进谨慎和深思熟虑的披露，以此作为支持留用的具体机制。 此外，ABBT将适用于只会说一种西班牙语的人，因为这群PWH需要更多 研究关注。在成功完成拟议的R34研究后，这项研究将有助于 重要的可操作数据，将为大规模调查ABBT的出院奠定基础 使用物质的PWH。

PROJECT SUMMARY/ABSTRACT As many as 50% of people with HIV (PWH) are not in regular HIV primary care in the U.S. This is particularly common for PWH who use substances such as cocaine, methamphetamines, and opioids. PWH 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 develop impactful, brief intervention techniques that can be easily integrated into usual care practices to enhance HIV care retention. The objective of this proposal, which is the next step in attaining the long-term goal, is to adapt and refine an existing retention intervention in the context of an open trial and a small randomized controlled trial. We will adapt a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care for people who use substances by targeting stigma. ABBT promotes an accepting stance towards life’s challenges and encourages participants to thoughtfully disclose the serostatus and/or substance abuse problems as a behavioral step towards challenging stigmatization fears. The central hypothesis is that increased tolerance of stigmatization, facilitated through increased acceptance of HIV status and substance abuse behaviors, will increase PWH’s longitudinal commitment to care. The aims of this proposal are: (1) To use an iterative process to refine ABBT for substance using, out-of- care PWH by conducting an open trial in English-speakers (n=7) and monolingual Spanish speakers (n=3); and, (2) To conduct a pilot randomized controlled trial (n = 50; incl. 10 Spanish speakers) of ABBT vs. Treatment-as-Usual (TAU). Primary outcome will be retention in care. The sample will consist of 60 HIV patients who have not attended a medical visit in at least 9 months at our infectious diseases clinic in Providence, R.I. The approach is innovative in that it departs from the status quo by using brief acceptance- based psychotherapy techniques, delivered by telehealth, to increase acceptance of HIV status and substance abuse problems and promoting careful and thoughtful disclosure as a specific mechanism to support retention. Additionally, ABBT will be adapted for monolingual Spanish speakers as this cohort of PWH needs more research attention. Upon successful completion of the proposed R34 research, this study will contribute significant actionable data that will lay the groundwork for a large-scale investigation of ABBT for out-of-care PWH who use substances.