Tailored Response to Psychiatric Comorbidity to Improve HIV Care Engagement in the United States (TRACE)

针对精神合并症的定制应对措施以改善美国的艾滋病毒护理参与度 (TRACE)

• 批准号: 10018934
• 负责人: Brian W Pence
• 金额: $ 30.33万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10018934
• 关键词: Address; Adherence; Adopted; Adult; Affect; Alcohol consumption; Alcohol or Other Drugs use; Anti-Retroviral Agents; Anxiety; Behavioral; Caring; Clinic; Clinical; Cognitive; Cognitive Therapy; Community Health; Depressive disorder; Diagnosis; Disease; Elements; General Population; Goals; HIV; Health; High Prevalence; Individual; Intervention; Iraq; Left; Mental Depression; Mental Health; Mental disorders; Outcome; Patients; Pharmacology; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Provider; Psychiatrist; Psychologist; Research; Resources; Social Workers; Substance Use Disorder; Supervision; Survivors; Testing; Thailand; Time; Training; Trauma; Treatment Failure; United States; Viral; Vulnerable Populations; Washington; antiretroviral therapy; arm; base; comorbidity; depressive symptoms; design; dual diagnosis; effectiveness testing; flexibility; improved; low income country; medication compliance; mortality; negative affect; post-traumatic stress; primary care setting; programs; randomized trial; response; scale up; secondary outcome; service providers; success; therapy design

PROJECT SUMMARY (ABSTRACT) Among adults living with HIV in the United States, between 20% and 40% are affected by depression. Depression negatively affects retention in care, antiretroviral (ART) adherence, sustained viral suppression, and survival. The majority of HIV patients with a depressive disorder also have one or more co-existing anxiety, post-traumatic stress, alcohol, or substance use disorders. These co-occurring disorders both complicate depression treatment and, if left untreated, represent additional important barriers to HIV treatment. To comprehensively address the psychiatric barriers to HIV care engagement, depression treatment interventions must be flexible enough to also address these psychiatric comorbidities. Standard pharmacological and psychotherapeutic interventions for depression, anxiety, PTSD, and substance use are effective among people with HIV.36-40 However, training interventionists in multiple protocols for multiple diagnoses is labor-intensive and leads to disconnects in treatment. As an alternative, recent advances in transdiagnostic interventions offer a promising unified framework for comprehensively addressing psychiatric comorbidity while enhancing HIV care engagement. Transdiagnostic treatment approaches capitalize on the common elements in interventions for depression, anxiety, PTSD, and substance use to offer tailored, integrated treatment to individuals presenting with any combination of the disorders. One such proven transdiagnostic intervention, the Common Elements Treatment Approach, or CETA, is based on the elements of cognitive behavioral therapy common to treatments for depression, anxiety, PTSD, and substance use disorders. CETA was developed to be delivered in low-income countries by supervised lay health workers, and has demonstrated efficacy in improving depression, anxiety, and PTSD among survivors of trauma in Thailand and Iraq; it has further been adopted for community health roll-out by the state of Washington. CETA has not previously been adapted for the particular needs of people living with HIV or specifically to address HIV care engagement. However, CETA is ideally positioned for this purpose because of its unified approach to treating psychiatric comorbidity, the ease of integrating additional cognitive behavioral content relating to HIV care engagement, and its design for delivery by non-specialists. We propose to adapt CETA for the particular needs of adults receiving HIV care in the US and pilot-test the adapted intervention to assess acceptability, feasibility, fidelity, and preliminary indications of impact. We hypothesize that the adapted CETA intervention will be acceptable to patients and providers, will prove feasible to integrate in a busy HIV primary care setting, will be delivered with fidelity, and will demonstrate preliminary indications of impact in improving HIV and mental health outcomes. This proposal will generate critical evidence to guide the design of a full-scale RCT to test the effectiveness of the adapted CETA protocol in improving HIV treatment and mental health outcomes for this vulnerable population.

项目摘要（摘要） 在美国患有艾滋病毒的成年人中，有20％至40％的人受抑郁症的影响。 抑郁会对护理，抗逆转录病毒（ART）依从性，持续病毒抑制的保留产生负面影响， 和生存。大多数患有抑郁症的艾滋病毒患者也有一个或多个共存 焦虑，创伤后压力，酒精或物质使用障碍。这些同时发生的疾病都 使抑郁症治疗复杂化，如果未治疗，则代表了艾滋病毒治疗的其他重要障碍。 全面解决艾滋病毒护理参与，抑郁症治疗的精神障碍 干预措施必须足够灵活，以解决这些精神病合并症。 抑郁，焦虑，PTSD和 在艾滋病毒患者中，药物使用是有效的。36-40，培训干预者多重 用于多次诊断的方案是劳动密集型的，导致治疗中断开连接。作为替代方案 转诊干预措施的最新进展为全面的统一框架提供了一个有希望的统一框架 在增强艾滋病毒护理参与的同时，解决精神病合并症。转诊治疗 方法可以利用抑郁，焦虑，PTSD和物质干预措施中的共同元素 用于提供量身定制的综合治疗，以表现出任何疾病组合的人。 一种经过验证的经诊断干预措施，常见元素治疗方法或CETA是 基于抑郁症，焦虑，PTSD治疗的认知行为疗法的元素 和药物使用障碍。 CETA的开发是由有监督的Lay在低收入国家交付的 卫生工作者，并在幸存者中表现出改善抑郁，焦虑和PTSD的功效 泰国和伊拉克的创伤；它已被它进一步通过 华盛顿。 CETA以前尚未适应艾滋病毒或艾滋病毒或 专门针对艾滋病毒护理参与。但是，CETA的理想位置是为此目的 它统一的治疗精神病合并症的方法，即融合其他认知行为的易度性 与艾滋病毒护理参与度有关的内容及其由非专家提供的设计。 我们建议将CETA适应美国接受艾滋病毒护理的成年人的特殊需求，并进行试验测试 改编干预措施以评估可接受性，可行性，保真度和初步影响。我们 假设适应的CETA干预将被患者和提供者接受，这将是可行的 为了整合繁忙的艾滋病毒初级保健环境，将以忠诚交付，并将展示初步 改善艾滋病毒和心理健康结果的影响的指示。该建议将产生关键 指导全尺度RCT设计以测试改编的CETA方案的有效性的证据 改善易受伤害人群的艾滋病毒治疗和心理健康结果。