Adaptation of the Friendship Bench counseling intervention to improve mental health and HIV care engagement outcomes among people living with HIV who inject drugs in Vietnam

项目总结 注射吸毒是东南亚艾滋病毒流行的主要驱动力。2017年，艾滋病毒流行率 在东南亚注射毒品者中(PWID)的比例为15%。PWID，他们中的大多数人使用阿片类药物 精神障碍(OUD)，艾滋病毒检测、护理滞留、开始抗逆转录病毒治疗(ART)和病毒感染的比率较低 压制。PWID还经历了与艾滋病毒相关的高死亡率和全因死亡率。普通心理 精神障碍(CMD)，包括抑郁、焦虑和与压力相关的疾病，发生在40%-50%的PLWH和 并与艾滋病毒患者的负面后果密切相关，包括艾滋病毒病程恶化， 更快地发展为艾滋病，更多的抗逆转录病毒药物不遵守，以及更高的死亡率。 为了应对低收入和中等收入国家对精神卫生治疗的巨大需求，全球 心理健康领域一直专注于开发任务转移和整合方法，为非 专家大规模提供基于证据的心理健康干预。然而，这样的任务转移 在东南亚，针对慢性精神疾病的干预措施在乌德中受到的关注有限。越南，与 其PLWH和OUD的高流行率，将美沙酮维持治疗与艾滋病毒护理相结合，以及 它优先为这一人群发展CMD护理，是评估任务转移心理的理想环境 解决慢性阻塞性肺疾病和改善艾滋病毒护理结果的卫生方法。 友谊长椅(FB)是一种可行而有效的任务转移心理健康干预工具，旨在 低资源设置，是解决此人群中的CMD的有力候选者。FB是一个解决问题的方法 以治疗为基础的干预措施在以下情况下对初级保健患者的CMDs具有证明的有效性 由业馀辅导员提供。非专业顾问可以有效地将FB与OUD一起交付给PLWH，但CMD可能会 事实证明，OUD患者的治疗难度更大，需要经过专业培训的顾问才能有效。 我们在这项提案中的目标是完成一项针对来自4家MMT诊所的75名患者的试点随机试验 河内。我们的具体目标是：1)调整友谊工作台(FB)协议以优化PLWH和 OUD在越南；2)在三组独立随机试验中试验适应的FB，将FB与 由非专业辅导员提供专业辅导员，以加强对妇幼保健院和妇幼保健院的日常护理；以及 3)评估改编后的FB及其初步指标的可行性、逼真度和可接受性 在改善慢性精神疾病和参与艾滋病毒护理和药物使用治疗方面的影响。友谊长椅 该方法有可能为解决慢性阻塞性肺疾病和减少艾滋病毒的障碍做出重要贡献 PLWH与OUD之间的治疗成功，OUD是推动越南艾滋病毒流行的关键人群，以及许多 东南亚国家。这项提议将为设计一个完全强大的临床提供关键证据。 试验以测试我们调整后的FB方案在改善艾滋病毒、精神健康和药物使用治疗结果方面的作用 弱势群体。

PROJECT SUMMARY Injection drug use is the primary driver of the HIV epidemic in Southeast Asia. In 2017, the HIV prevalence among people who inject drugs (PWID) in Southeast Asia was 15%. PWID, most of whom have opiate use disorder (OUD), have low rates of HIV testing, retention in care, antiretroviral therapy (ART) initiation, and viral suppression. PWID also experience high rates of HIV-related and all-cause mortality. Common mental disorders (CMDs), including depressive, anxiety, and stress-related illnesses, occur in 40-50% of PLWH and OUD and are strongly associated with negative outcomes for HIV patients, including worsening course of HIV, more rapid progression to AIDS, increased ART non-adherence, and increased mortality rates. To respond to the great need for mental health treatment in low- and middle-income countries, the global mental health field has focused on developing task-shifting and integration approaches that equip non- specialists to deliver evidence-based mental health interventions at scale. However, such task shifting interventions to address CMDs have received limited attention in Southeast Asia among OUD. Vietnam, with its high prevalence of PLWH and OUD, its integration of methadone maintenance therapy with HIV care, and its priority for developing CMD care for this population, is an ideal setting to evaluate task-shifting mental health approaches to address CMDs and improve HIV care outcomes. The Friendship Bench (FB) is a feasible and effective task-shifting mental health intervention designed for low-resource settings that is a strong candidate to address CMDs in this population. FB is a problem solving therapy-based intervention with demonstrated effectiveness treating CMDs among primary care patients when delivered by lay counselors. Lay counselors may effectively deliver FB to PLWH with OUD, but CMD may prove more difficult to treat in patients with OUD and require professionally trained counselors to be effective. Our objective in this proposal is to complete a pilot randomized trial of 75 patients from 4 MMT clinics in Hanoi. Our specific aims are: 1) To adapt the Friendship Bench (FB) protocol to be optimized for PLWH and OUD in Vietnam; 2) To pilot the adapted FB in a three-arm individually randomized trial, comparing FB by professional counselors to FB by lay counselors to enhanced usual care for PLWH and OUD with CMDs; and 3) To assess the feasibility, fidelity, and acceptability of the adapted FB as well as preliminary indicators of its impact in improving CMD and engagement in HIV care and drug use treatment. The Friendship Bench approach has the potential to make an important contribution to address CMDs and reduce barriers to HIV treatment success among PLWH with OUD, a critical population driving the HIV epidemic in Vietnam and many Southeast Asian countries. This proposal will generate critical evidence for designing a fully powered clinical trial to test our adapted FB protocol in improving HIV, mental health, and drug use treatment outcomes for this vulnerable population.