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

项目概要（摘要） 在美国，20%至40%的艾滋病毒感染者患有抑郁症。 抑郁症对护理保留、抗逆转录病毒（ART）依从性、持续的病毒抑制、 和生存大多数患有抑郁症的HIV患者也有一种或多种共存的 焦虑、创伤后压力、酒精或物质使用障碍。这些并发症 使抑郁症治疗复杂化，如果不治疗，则会成为艾滋病毒治疗的另一个重要障碍。 为了全面解决艾滋病毒护理参与的精神障碍，抑郁症治疗 干预措施必须足够灵活，以解决这些精神病合并症。 抑郁症、焦虑症、创伤后应激障碍和 36 -40然而，在多个领域培训干预人员， 多种诊断的协议是劳动密集型的，并导致治疗中断。作为替代方案， 跨诊断干预措施的最新进展为全面研究提供了一个有希望的统一框架。 解决精神科并发症，同时加强艾滋病毒护理参与。跨诊断治疗 这些方法利用了抑郁、焦虑、创伤后应激障碍和物质干预的共同要素 用于为患有所述病症的任何组合的个体提供定制的综合治疗。 其中一种经过验证的跨诊断干预，即共同要素治疗方法，或CETA， 基于认知行为疗法的元素，这些元素与抑郁症、焦虑症、创伤后应激障碍、 和物质使用障碍。CETA的开发是为了在低收入国家由受监督的外行提供 卫生工作者，并已证明在改善幸存者的抑郁症，焦虑症和创伤后应激障碍的疗效 在泰国和伊拉克的创伤;它已被进一步采用的社区卫生推出的国家 华盛顿。CETA以前没有适应艾滋病毒感染者的特殊需要， 特别是针对艾滋病毒护理工作。然而，CETA是理想的定位，因为这一目的， 其治疗精神病合并症的统一方法，整合额外的认知行为的容易性， 与艾滋病毒护理参与有关的内容，以及由非专业人员提供的设计。 我们建议调整CETA，以满足美国接受艾滋病毒护理的成年人的特殊需求，并对CETA进行试点测试。 调整干预措施，以评估可接受性、可行性、保真度和影响的初步迹象。我们 假设适应的CETA干预将被患者和提供者接受，将证明是可行的 整合在一个忙碌艾滋病毒初级保健设置，将提供与保真度，并将展示初步 改善艾滋病毒和心理健康结果的影响指标。该提案将产生重大影响。 证据，以指导设计一个全面的随机对照试验，以测试适应CETA协议的有效性， 改善这一弱势群体的艾滋病毒治疗和心理健康结果。

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.