Treating Chronic Pain and Depression in HIV Patients in Primary Care Settings

描述（由申请人提供）：在高效抗逆转录病毒治疗（HAART）的时代，艾滋病毒日益成为一种慢性疾病。疼痛的经历现在经常发生在整个感染过程中，30-65%的艾滋病毒患者患有慢性疼痛，这种疼痛是频繁的，严重的，可能是不可逆转的，并且干扰了日常活动。对于大多数人来说，没有完全有效的非药物治疗方法可以改善疼痛结果。开发一种新的疼痛治疗方法是复杂的，因为在艾滋病毒患者中，疼痛通常与抑郁症同时发生，抑郁症是艾滋病毒患者中最常见的精神健康障碍之一。该项目将开发一种协作治疗，其中行为健康专家（BHS：社会工作者、护士、心理学家）和初级保健提供者（pcp）共享一个统一的计划，以解决在社区卫生中心初级保健环境中接受艾滋病毒护理的患者的疼痛和抑郁问题。这项名为HIVPASS （HIV疼痛和悲伤研究）的合作疗法建立在行为疗法的基础上，旨在减少行为回避和增加行为激活，同时解决这两种情况。具体目标的实现将分两个阶段进行。首先，我们将进行HIVPASS的公开试验（n=10）。接下来，我们将进行一项试验性随机临床试验（n=30），有两个治疗组，HIVPASS和健康教育。疼痛将是评估的主要结果变量，抑郁和抗逆转录病毒依从性将是次要结果变量。这个项目的目的是：1。发展和完善hiv - pass，使其符合初级保健医生（pcp）、行为健康专家（BHSs）和参与者（公开试验和试点随机对照试验）的可行性和接受性标准；a.编写、实地测试并最终确定HIVPASS手册；b.制定BHS遵守手册的可靠措施；c.制定、现场测试并最终确定BHS培训和监督程序；2. 完善研究流程（如同意流程、随机化流程和评估流程），并在确定招募目标的同时，确定其对参与者的可行性和可接受性（试点RCT）。这一行

DESCRIPTION (provided by applicant): In the era of Highly Active Antiretroviral Treatment (HAART), HIV is increasingly a chronic illness. The experience of pain now often occurs over the entire course of infection, with 30-65% of HIV patients having chronic pain that is frequent, severe, may not be reversible, and interferes with daily activities. For most, no fully effective non-pharmacological therapies exist to improve pain outcomes. Developing a novel pain treatment is complicated by the fact that among HIV patients, pain often co- occurs with depression, one of the most common mental health disorders in HIV patients. This project will develop a collaborative treatment, in which behavioral health specialists (BHS: social workers, nurses, psychologists) and primary care providers (PCPs) share a unified plan for addressing pain and depression in patients receiving HIV care in a Community Health Center primary care setting. This collaborative therapy, entitled HIVPASS (HIV Pain And Sadness Study), builds upon behavior therapy that targets a reduction in behavioral avoidance and an increase in behavioral activation to address both conditions concurrently. Achievement of the Specific Aims will occur in the context of two phases. First, we will conduct an open trial of HIVPASS (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) with two treatment arms, HIVPASS and Health Education. Pain will be the primary outcome variable assessed, and depression and antiretroviral adherence will be the secondary outcome variables. The Aims of this project are: 1. To develop and refine HIVPASS so that it meets standards of feasibility and acceptability for primary care physicians (PCPs), behavioral health specialists (BHSs), and participants (open trial and pilot RCT); a. To develop, field-test, and finalize a HIVPASS manual; b. To develop a reliable measure of BHS adherence to the manual; c. To develop, field-test, and finalize BHS training and supervision procedures; 2. To refine research procedures (e.g., consent process, randomization process, and assessment procedures), and establish their feasibility and acceptability to participants (pilot RCT) while confirming recruitment goal targets. This line of work could lead to the incorporation of theoretically-driven and effective treatment for patients with pain and depression into HIV care. This would be the first empirically-tested therapy protocol that specifically integrates treatment of these conditions in HIV research. We believe that this treatment will lead to improved pain and depression outcomes in population.