Implementing Evidence-Based Treatment for Common Mental Disorders in HIV Clinics in Ukraine

在乌克兰艾滋病毒诊所对常见精神疾病实施循证治疗

• 批准号: 10762576
• 负责人: Kimberly Michelle Hook
• 金额: $ 19.06万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762576
• 关键词: Address; Adherence; Adult; Adverse effects; Aftercare; Anxiety; Area; Behavioral; Caring; Clinic; Cognitive Therapy; Collaborations; Communities; Conflict (Psychology); Continuity of Patient Care; Country; Data; Data Analyses; Diagnostic; Eastern Europe; Elements; Epidemic; European; Evidence based intervention; Evidence based treatment; Genetic Complementation Test; Goals; HIV; HIV Infections; HIV/AIDS; Health Personnel; Impairment; Incidence; Income; Intervention; Interview; Knowledge; Learning; Life; Link; Mediating; Mediation; Mediator; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Nurses; Outcome; Pathway interactions; Persons; Physicians; Population; Protocols documentation; Psychologist; Public Health; Publications; Randomized; Reporting; Research; Research Priority; Resources; Sampling; Site; Testing; Training; Treatment outcome; Ukraine; United States National Institutes of Health; Viral; War; antiretroviral therapy; attentional control; biological sex; clinically relevant; common symptom; common treatment; comorbidity; contextual factors; depressive symptoms; design; efficacy study; evidence base; experience; follow-up; improved; innovation; interest; negative affect; post-traumatic stress; primary outcome; psychologic; randomized, clinical trials; reduce symptoms; satisfaction; secondary outcome; sex assigned at birth; therapy adherence

PROJECT SUMMARY From 2010-2020, Eastern Europe reported a 72% increase in new adult HIV infections, representing the highest rate of increase globally. Among the Eastern European countries, the HIV epidemic in Ukraine is one of the largest, with nearly 260,000 people with HIV (PWH). Nevertheless, in 2020, only 54% of Ukrainian PWH were on antiretroviral therapy (ART), and only 51% were virally suppressed. These suboptimal HIV care continuum outcomes are partially attributable to mental disorders, which are more prevalent among PWH generally (and in Ukraine specifically) and have been linked to decreased ART adherence and poor engagement in HIV care. To minimize the adverse effects of impaired mental health on HIV outcomes, creating a pathway to increase access to evidence-based mental health care is a critical public health need. The long- term goal of this applicant is to develop expertise in testing transdiagnostic mental health interventions to improve HIV outcomes among PWH in Ukraine. The objective of this K23 application is to adapt the Common Elements Treatment Approach (CETA), by incorporating the single-session Life Steps ART adherence intervention, to reduce symptoms of depression, anxiety, and posttraumatic stress among PWH in Ukraine. The central hypothesis to be tested is that the adapted CETA plus Life-Steps intervention will improve both HIV and mental health outcomes among PWH in Ukraine. The strong preliminary data supporting this application shows that community psychologists in Ukraine feel they do not have adequate knowledge to deliver mental health treatment but nonetheless have strong interest in learning short-term treatments such as CETA. To test the central hypothesis, the following specific aims are proposed: (1) To define relevant clinical and contextual factors for adapting CETA for delivery in HIV clinics and for integrating Life-Steps into the existing protocol; (2) To determine the feasibility, acceptability, and preliminary efficacy of the adapted CETA plus Life-Steps intervention; and (3) To estimate potential mediators and moderators of the adapted CETA plus Life-Steps intervention. The expected outcome of this K23 is that this applicant will gain the expertise needed in the three critical training areas of HIV and mental health, design of randomized clinical trials, and longitudinal data analysis necessary to achieve research independence. The key innovation is that this study will be the first to combine CETA with Life-Steps and evaluate its preliminary efficacy in a low- or middle-income country setting. The resulting preliminary data will also support a compelling R01 application, to be submitted in year 4 of the K23 award period, to test the adapted CETA plus Life-Steps intervention in a fully-powered, multi-site efficacy study in Ukraine. If successful, the proposed research will have significant public health impact by providing an evidence-based intervention for treating mental health problems among PWH, with attendant implications for addressing the dual mental health crisis and HIV epidemic in PWH populations throughout Eastern Europe.

项目摘要 从2010年到2020年，东欧报告的新成人艾滋病毒感染增加了72%， 全球增长率最高。在东欧国家中，乌克兰的艾滋病毒疫情是一个 其中最大的一个，有近260，000名艾滋病毒感染者（PWH）。然而，到2020年，只有54%的乌克兰PWH 接受抗逆转录病毒治疗（ART）的患者中，只有51%的人受到病毒抑制。这些不理想的艾滋病护理 持续性结果部分归因于精神障碍，精神障碍在威尔斯亲王医院中更为普遍 一般来说（特别是在乌克兰），并已与减少抗逆转录病毒疗法坚持和穷人 参与艾滋病护理。为了尽量减少心理健康受损对艾滋病毒结果的不利影响， 增加获得循证精神卫生保健的途径是一项关键的公共卫生需求。很长的- 本申请人的长期目标是发展测试跨诊断心理健康干预的专业知识， 改善乌克兰公共卫生服务提供者的艾滋病毒防治成果。此K23应用程序的目标是调整通用 元素治疗方法（CETA），通过纳入单次会议的生活步骤ART坚持 在乌克兰，我们正在进行干预，以减少PWH中的抑郁、焦虑和创伤后压力症状。 有待检验的中心假设是，经过调整的CETA加生活步骤干预将改善艾滋病毒感染和艾滋病感染。 和精神健康结果之间的PWH在乌克兰。支持这一申请的有力的初步数据 显示，乌克兰的社区心理学家认为他们没有足够的知识来提供心理咨询， 健康治疗，但仍然有强烈的兴趣学习短期治疗，如CETA。测试 中心假设，提出以下具体目标：（1）定义相关的临床和背景 调整CETA在艾滋病诊所分娩和将生命步骤纳入现有方案的因素;（2） 确定调整后的CETA加生活步骤的可行性、可接受性和初步疗效 评估适应性CETA加生活步骤的潜在中介和调节因素 干预K23的预期结果是，申请人将获得三个领域所需的专业知识。 艾滋病毒和心理健康的关键培训领域，随机临床试验的设计，以及纵向数据 分析，以实现研究的独立。关键的创新是，这项研究将是第一个 联合收割机结合CETA与生活步骤，并评估其在低收入或中等收入国家环境中的初步疗效。 由此产生的初步数据也将支持一个令人信服的R 01申请，将在2010年的第4年提交。 K23奖励期，以测试调整后的CETA加Life-Steps干预在全功率、多部位的有效性 研究在乌克兰.如果成功，拟议的研究将通过提供一个 循证干预治疗威尔斯亲王医院精神健康问题， 解决东欧地区威尔斯亲王医院患者的双重精神健康危机和艾滋病毒流行问题。