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年至2020年，东欧报告了新的成年艾滋病毒感染增长72％，代表 全球增长率最高。在东欧国家中，乌克兰的艾滋病毒流行是 最大的人中有近260,000人患有艾滋病毒（PWH）。尽管如此，在2020年，只有54％的乌克兰PWH 正在接受抗逆转录病毒疗法（ART），只有51％被病毒抑制。这些次优的艾滋病毒护理 连续性结果部分归因于精神障碍，在PWH中更普遍 通常（特别是在乌克兰），并且与依从性降低和贫困 参与艾滋病毒护理。为了最大程度地减少心理健康受损对艾滋病毒结果的不利影响，创造 增加获得循证心理保健机会的途径是公共卫生的关键需求。长期 该申请人的术语目标是开发用于测试转诊性心理健康干预措施的专业知识 改善乌克兰PWH的艾滋病毒结局。该K23应用的目的是适应共同 元素治疗方法（CETA），通过合并单会生命步骤艺术依从性 干预，以减少乌克兰PWH中抑郁症，焦虑和创伤后压力的症状。 要测试的中心假设是改编的CETA Plus LifeSteps干预措施将改善HIV 乌克兰PWH中的心理健康结果。支持此应用程序的强大初步数据 表明乌克兰的社区心理学家认为他们没有足够的知识来提供精神 健康治疗，但仍然对学习短期治疗（例如CETA）有浓厚的兴趣。测试 中心假设提出了以下特定目的：（1）定义相关的临床和上下文 适应CETA在艾滋病毒诊所进行交付的因素，并将寿命置于现有方案中； （2） 确定改编的CETA和生命步骤的可行性，可接受性和初步功效 干涉; （3）估计适应性CETA和生命步骤的潜在介体和主持人 干涉。该K23的预期结果是，该申请人将获得三个中所需的专业知识 艾滋病毒和心理健康的关键训练领域，随机临床试验的设计和纵向数据 实现研究独立性所必需的分析。关键创新是这项研究将是第一个 将CETA与生命步骤结合使用，并在低收入或中等收入的国家环境中评估其初步疗效。 由此产生的初步数据还将支持引人注目的R01应用程序，将在第4年 K23奖励期，以测试适应的CETA和LifeSteps干预措施 在乌克兰学习。如果成功，拟议的研究将通过提供一个重大的公共卫生影响 基于证据的干预措施治疗PWH中的心理健康问题，对 解决东欧PWH人群中的双重心理健康危机和HIV流行。