Behavioral Consultation for HIV+ Older Adults Prescribed Opioids for Chronic Pain

描述（由申请人提供）：HIV人群正在老龄化，大约50%的HIV患者报告慢性疼痛。多达20%的人接受慢性阿片类药物治疗的处方，滥用这些药物是常见的。因此，对慢性疼痛治疗存在双边不满：许多患者没有报告症状完全缓解，艾滋病毒初级保健提供者（HIV- pcp）表达了对阿片类药物滥用的担忧。经常出现一个问题循环：疼痛更严重的艾滋病毒患者更有可能滥用阿片类药物，而pcp不愿开出足够剂量的镇痛药，可能导致患者通过滥用或使用非法药物来寻求疼痛缓解。此外，这种不满可能导致患者与提供者之间的不良联盟，而这对艾滋病毒治疗和抗逆转录病毒治疗的依从性很重要。尽管存在这些担忧，但很少研究干预措施来减少处方阿片类药物的滥用；没有一种是专门为艾滋病患者开发的。该项目将针对老年艾滋病毒阳性成人滥用处方阿片类药物的情况，制定一项协作性、简短的行为咨询干预措施。干预，CHOACOT （HIV+老年人慢性阿片类药物治疗咨询），可能包括：1)行为健康顾问（BHC）和患者之间的三次会议，2)BHC和HIV- pcp之间的两次简短咨询，以及3)患者，BHC和HIV- pcp的联席会议。CHOACOT将以初级保健行为咨询模型和行为治疗技术为基础，包括动机访谈和功能评估。为了实现我们的目标，我们将从迭代开放试验（n=10）开始开发CHOACOT。接下来，我们将进行CHOACOT与常规强化治疗的随机临床试验（n=30）。阿片类药物滥用将是主要的结局变量。医患关系的质量、疼痛、其他药物的使用问题、抗逆转录病毒依从性和社会心理功能将是次要结果。具体目标是：目标1。发展和完善CHOACOT，使其符合艾滋病毒pcp、BHCs和参与者的可行性和可接受性标准；1一个。开发和现场测试CHOACOT BHC手册；1 b。制定一种可靠的BHC手册依从性测量方法；1 c。制定和现场测试BHC培训和监督程序。目标2。完善研究程序（如同意和随机化过程，评估程序），在确定招募目标的同时，确定其可行性和可接受性。这方面的工作可能导致将一种理论驱动和经验检验的简短干预措施纳入艾滋病毒护理中，针对那些服用阿片类药物治疗慢性疼痛并担心滥用阿片类药物的老年艾滋病毒患者。

DESCRIPTION (provided by applicant): The HIV population is aging and approximately 50% of HIV patients report chronic pain. Up to 20% receive prescriptions for chronic opioid therapy, and misuse of these medications is common. There is thus bilateral dissatisfaction with chronic pain treatment: many patients do not report full symptom relief and HIV primary care providers (HIV-PCPs) express concern about opioid misuse. A problematic cycle frequently arises: HIV patients with more severe pain are more likely to misuse opioids, and PCPs' reluctance to prescribe adequate doses of analgesics may lead patients to seek pain relief by such misuse or by use of illicit drugs. Further, this dissatisfaction can lead to poor patient-provider alliance, which is important in HIV treatment and antiretroviral adherence. Despite these concerns, few interventions have been studied to decrease misuse of prescribed opioids; none have been developed specifically for HIV patients. This project will develop a collaborative, brief, behavioral consultation intervention targeting misuse of prescribed opioids in older HIV+ adults. The intervention, CHOACOT (Consultation for HIV+ Older Adults on Chronic Opioid Therapy), will likely consist of: 1) three meetings between the Behavioral Health Consultant (BHC) and the patient, 2) two brief consultations between the BHC and the HIV-PCP, and 3) a joint meeting of the patient, BHC, and HIV-PCP. CHOACOT will be based on the primary care behavioral consultation model and behavior therapy techniques including motivational interviewing and functional assessment. To achieve our aims, we will develop CHOACOT beginning with an iterative open trial (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) of CHOACOT versus enhanced Treatment-As-Usual. Opioid misuse will be the primary outcome variable. Quality of the patient-provider relationship, pain, problematic use of other substances, antiretroviral adherence, and psychosocial functioning will be secondary outcomes. The specific aims are: Aim 1. Develop and refine CHOACOT so that it meets standards of feasibility and acceptability for HIV PCPs, BHCs, and participants; 1a. To develop and field test a CHOACOT BHC manual; 1b. To develop a reliable measure of BHC manual adherence; 1c. To develop and field-test BHC training and supervision procedures. Aim 2. Refine research procedures (e.g., consent and randomization processes, assessment procedures), and establish their feasibility and acceptability to participants while confirming recruitment goal targets. This lineof work could lead to the incorporation into HIV care of a theoretically-driven and empirically- tested brief intervention for older HIV patients who are prescribed opioids for chronic pain and for whom there is concern about opioid misuse.