Targeting HIV Retention and Improved Viral load through Engagement ('THRIVE')

通过参与（“THRIVE”）瞄准艾滋病毒保留和改善病毒载量

• 批准号: 10082597
• 负责人: Lilian Nazar Dindo
• 金额: $ 22.01万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082597
• 关键词: Address; Affect; Alcohol or Other Drugs use; Anxiety; Behavior; Behavior Therapy; Caring; Chronic; Chronic Disease; Clinic; Clinical; Data; Diagnosis; Effectiveness; Epidemic; Failure; Feedback; Goals; Grant; HIV; HIV Infections; Health; Hospitalization; Hospitals; Hour; Individual; Intervention; Jail; Life; Mental Depression; Mental Health; Mental Health Services; Methods; Morbidity - disease rate; Outcome; Outpatients; Patients; Persons; Population; Positioning Attribute; Primary Health Care; Prisons; Process; Protocols documentation; Randomized Clinical Trials; Randomized Controlled Trials; Research; Self Efficacy; Sexually Transmitted Diseases; Substance abuse problem; Target Populations; Telephone; Testing; Therapeutic; Therapeutic Intervention; United States; United States National Institutes of Health; Value of Life; Viral; Viral Load result; Viremia; Work; antiretroviral therapy; barrier to care; base; care providers; comorbidity; coping; efficacy testing; experience; financial incentive; follow-up; health disparity; improved; improved outcome; innovation; interest; medical specialties; mortality; multidisciplinary; outreach; peer; prevent; psychosocial; racial and ethnic disparities; randomized trial; social stigma; successful intervention; transmission process; treatment as usual; treatment program; trend; viral RNA

Summary/ abstract: Poor retention in HIV primary care results in lower rates of HIV viral suppression, higher rates of HIV transmission, and exacerbates racial and ethnic disparities in health outcomes, including survival. To date, there are no interventions that effectively relink and retain PWH in care when they are found outside the HIV clinic. Many persons with HIV infection (PWH) are hospitalized with life-threatening but preventable complications of inadequately treated HIV infection. They are among the most important patients to retain in care. Our previous research shows that among PWH who are out of care and hospitalized, avoidance coping, stigma, and mental health difficulties were nearly universal. Further, avoidance coping was a predictor of failure to re-engage in care after discharge. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention with the capacity to address a range of psychosocial and behavior-related issues that PWH experience. ACT helps patients overcome avoidance, particularly avoidance of uncomfortable internal states and the situations that trigger such states, by promoting acceptance-based coping and re-engagement in meaningful and valued-life activities. Brief ACT interventions appear to be feasible, acceptable, and at least preliminarily, have efficacy. We propose to develop, refine, and pilot a brief (4-5 contact hours) ACT intervention for hospitalized, out-of-care PWH. `Targeting HIV Retention and Improved Viral load through Engagement' (`THRIVE') will aim to help patients overcome avoidance, a maladaptive coping strategy implicated in a range of problems, including depression, anxiety, substance abuse, and HIV-related self-stigma, all of which constitute barriers to care. Delivering THRIVE in the hospital with a phone booster session after discharge will increase therapy initiation and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services for PWH. In Aim 1, a brief hospital-based transdiagnostic, individually delivered ACT intervention (THRIVE) tailored specifically for out-of-care hospitalized PWH will be developed. Input from a multi-disciplinary team of expert care providers and PHW will be utilized to create the therapist protocol and patient workbook. We will then pilot THRIVE in 10 hospitalized out-of-care PWH who will provide qualitative feedback on the intervention. The feedback, along with input from patients and the multi-disciplinary team, will be used to refine THRIVE. In Aim 2, we will conduct a pilot randomized clinical trial (RCT) of the refined THRIVE intervention (N=35) compared to treatment as usual (N=35). This pilot RCT will 1) evaluate feasibility and acceptability for a full- scale RCT; and 2) examine trends in outcomes of interest for the definitive RCT. We will then be positioned to submit a separate grant to test the efficacy of THRIVE in a fully powered randomized trial. This work has the potential to decrease HIV morbidity and racial/ethnic disparities and contribute to ending the HIV epidemic in the United States, which are NIH priorities.

摘要/摘要： 对艾滋病毒初级保健的保留不佳导致较低的艾滋病毒抑制率，较高的艾滋病毒感染率 传播，并加剧了包括生存在内的健康结果方面的种族和族裔差异。到目前为止， 没有任何干预措施可以有效地重新联系和保留PWH，当他们被发现在HIV之外的时候 诊所。许多感染艾滋病毒(PWH)的人因有生命危险而住院治疗，但可以预防 艾滋病毒感染治疗不当的并发症。他们是留住的最重要的患者之一 关心。我们先前的研究表明，在离开护理和住院的威尔斯亲王医院中，避免 应对、耻辱和心理健康困难几乎是普遍存在的。此外，回避应对是一种 出院后未能重新参与护理的预测因素。接纳与承诺疗法(ACT)是一种 跨诊断干预，有能力解决一系列与心理社会和行为相关的问题 威尔斯亲王所经历的问题。ACT帮助患者克服回避，特别是避免 不舒服的内部状态和触发这种状态的情况，通过促进基于接受的 应对和重新参与有意义和有价值的生活活动。简短的ACT干预措施似乎是 可行、可接受，至少在初步情况下是有效的。我们建议开发、完善和试行 短暂(4-5个接触小时)对住院的、不在看护的威斯康星医院的ACT干预。‘目标是艾滋病毒滞留和 通过参与提高病毒载量(`THRIVE‘)将旨在帮助患者克服回避，a 适应不良的应对策略牵涉到一系列问题，包括抑郁、焦虑、物质 虐待和与艾滋病毒有关的自我羞辱，所有这些都构成了护理的障碍。交付在世界各地蓬勃发展 出院后有电话助推器的医院将增加治疗的开始和完成， 缺乏精神卫生往往是威尔斯亲王医院有效提供精神卫生服务的最大障碍。在目标1中， 专门定制的基于医院的跨诊断、个人提供的简短ACT干预(Thrive) 对于出院后住院的威尔斯亲王医院，将开发。来自多学科专家护理团队的意见 提供者和公共卫生工作人员将被用来创建治疗师方案和患者工作簿。然后我们将试行 在10个住院的出院威尔斯亲王医院，谁将提供干预的质量反馈。这个 反馈，以及来自患者和多学科团队的意见，将用于改进和蓬勃发展。在……里面 目的2，我们将进行改良Thrive干预(N=35)的先导性随机临床试验(RCT) 与常规治疗(N=35)比较。这项试点RCT将1)评估全面- 量表随机对照试验；以及2)检查最终随机对照试验所关注的结果的趋势。然后我们将定位于 提交一项单独的拨款，以在完全有效的随机试验中测试Thrive的疗效。这项工作有 有可能减少艾滋病毒发病率和种族/族裔差异，并有助于消除艾滋病毒 美国的疫情，这是美国国立卫生研究院的优先事项。