Brief Acceptance and Commitment Therapy for HIV-Infected At-Risk Drinkers

摘要 危险水平的酒精消费几乎对生活的每一步都有负面影响。 艾滋病毒护理连续体。这是艾滋病毒治疗中的一个关键因素，如果不加以解决， 进一步传播和治疗效果差。对艾滋病毒感染者的酒精干预措施 美国（US）的研究结果喜忧参半，没有对PLHW进行酒精干预的长期结果显示， 减少大量饮酒或对艾滋病毒相关结果产生重大影响。一个假设的原因是 这些干预措施未能解决多个重叠的问题（例如，共 病态的心理健康状况，行为健康需要）的PLWH谁是危险的饮酒者。创新 酒精干预策略可以对这些多种行为健康需求产生影响， 在艾滋病毒护理方面可以切实可行地提供。简短的接受和承诺 治疗（ACT）是一个有前途的干预艾滋病毒感染的危险饮酒者。ACT是一种跨诊断 使用正念技能和价值观指导的行为行动计划来影响广泛的治疗， 心理症状。ACT已显示出治疗焦虑、抑郁、慢性疼痛和 物质使用，使其成为危险饮酒者的一种有前途的方法。本申请的总体目标 是调整现有的简短ACT干预戒烟，并试点测试其可行性， 对那些危险饮酒者的可接受性。我们假设由此产生的干预将是 初步与减少酒精使用，改善ART依从性， 抑郁、焦虑和药物使用，以及增加的接受性--一种已知的ACT变化机制。的 具体目标如下：目标1-我们将调整现有的艾滋病毒感染者短期ACT干预措施， 危险饮酒者（ACT-AU）。我们将通过以下方式实现这一目标：修改5个会话，电话交付ACT 通过迭代的多学科团队会议，焦点小组讨论， HIV门诊患者（N = 15-20），以及与HIV门诊提供者的定性访谈（N = 5-10）。目标2-我们将 开展一项ACT-AU与短期ACT-AU相比的初步有效性比较随机临床试验（RCT）， 酒精干预以前显示减少艾滋病毒感染妇女的饮酒天数。要全面完成 该研究的目的是：随机分配N = 74名感染HIV的危险饮酒者（50%为女性）进行干预 在目标1中开发的，或短暂的酒精干预类似的治疗时间和频率。我们 将评估可行性、可接受性和初步试验结果。酒精使用和ART依从性将是 在随机化后6周和6个月通过自我报告和生物标志物进行评估;初步 接受程度的变化以及焦虑和抑郁的症状，以及药物使用也将被检查6- 随机化后3周和6个月。拟议的研究将为一项 R 01申请进行全面RCT，以确定ACT-AU的比较疗效。

Abstract Alcohol consumption at hazardous levels is associated with negative consequences on nearly every step of the HIV care continuum. It is a critical factor in HIV treatment that, if unaddressed, significantly contributes to onward transmission and poor treatment outcomes. Alcohol interventions for people living with HIV (PLWH) in the United States (US) have shown mixed results, and no alcohol intervention for PLHW has shown long-term reductions in heavy drinking or a significant impact on HIV-related outcomes. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co- morbid mental health conditions, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, making it a promising approach for hazardous drinkers. The overall objective of this application is to adapt an existing brief ACT intervention developed for smoking cessation, and pilot test its feasibility and acceptability for PLWH who are hazardous drinkers. We hypothesize that the resulting intervention will be preliminarily associated with decreased alcohol use, improved ART adherence, decreased symptoms of depression, anxiety, and drug use, and increased acceptance—a known mechanism of change in ACT. The specific aims are as follows: Aim 1—we will adapt an existing brief ACT intervention for HIV-infected hazardous drinkers (ACT-AU). We will accomplish this aim by: Modifying a 5-session, telephone-delivered ACT intervention for smoking cessation via iterative multidisciplinary team meetings, focus group discussions with HIV clinic patients (N = 15-20), and qualitative interviews with HIV clinic providers (N = 5-10). Aim 2—we will conduct a pilot comparative effectiveness randomized clinical trial (RCT) of ACT-AU compared to a brief alcohol intervention previously shown to reduce drinking days among HIV-infected women. We will accomplish this aim by: Randomly assigning N = 74 HIV-infected hazardous drinkers (50% women) to the intervention developed in Aim 1, or a brief alcohol intervention similar in length and frequency of treatment sessions. We will assess feasibility, acceptability, and preliminary trial outcomes. Alcohol use and ART adherence will be assessed via both self-report and biomarkers at 6-weeks and 6-months post-randomization; preliminary changes in acceptance as well as symptoms of anxiety and depression, and drug use will also be examined 6- weeks and 3 and 6-months post-randomization. The proposed research will provide essential pilot data for a R01 application to conduct a full-scale RCT to determine the comparative efficacy of ACT-AU.