Brief Acceptance-Based Retention Intervention for Newly Diagnosed HIV Patients

项目摘要/摘要 在与艾滋病毒护理挂钩后的头几个月里，医疗诊所的辍学率高达50%， 31%-46%的患者在第一次就诊后就退出了。艾滋病毒携带者(PLWH) 持续接受治疗的风险：抗逆转录病毒治疗(ART)开始延迟，ART减少 坚持、不受抑制的病毒血症和死亡率。此外，保留力差意味着有效的ART不能 用来防止艾滋病毒的进一步传播。长期目标是通过以下方式改善艾滋病毒护理级联 开发基于行为的干预措施，具有广泛的适用性，可以以最低的成本执行 以及在以社区为基础的艾滋病毒护理医疗环境中的努力。这项提议的目标是下一步 在实现长期目标并在我们成功的R34研究的基础上，进行一项全面的、 随机对照试验(RCT)评估一项简短的、基于接受的两阶段行为研究的效果 治疗(ABBT)干预，以加强艾滋病毒护理中的留存。中心假设是参与者的 向其支助系统成员通报艾滋病毒状况，通过增加 在医疗护理的早期接受艾滋病毒状况，将增加他们对护理的纵向承诺。 这项建议的目的是：(1)在双臂随机对照试验中，测试ABBT干预对 保留护理和病毒学抑制(主要结果)；以及，遵守抗逆转录病毒疗法，披露艾滋病毒状况， 感觉到的社会支持，艾滋病毒污名化(次要结果)，相对于加强治疗-作为- 通常情况；以及，(2)检查艾滋病毒护理和病毒学抑制的保留程度 通过(A)增加对艾滋病毒的接受(减少对艾滋病毒的经验回避)和(B)增加 愿意披露艾滋病毒状况。样本将包括270名新加入护理的艾滋病毒患者。 来自罗得岛州普罗维登斯和新泽西州普罗维登斯的两个不同地理和种族的大型艾滋病毒医疗保健机构 洛杉矶奥尔良。这种方法是创新的，因为它通过使用基于简短接受的方法来脱离现状 心理治疗技术，面对面和通过电话提供，以增加对艾滋病毒状况的接受和 促进仔细和深思熟虑的血清状况披露，以此作为支持保留和 病毒学抑制。在成功完成拟议的R01研究后，这项研究将有助于 阐明ABBT对医疗保健的影响和调节机制的重要可操作数据 滞留和病毒学抑制。因此，它将为传播一种简单、低成本的 可纳入常规艾滋病毒护理的干预措施。

Project Summary/Abstract Drop-out rates from medical clinics in the first months following linkage to HIV care are as high as 50%, with 31-46% of patients dropping out after the first visit. People Living with HIV (PLWH) who are not consistently retained in care are at risk for: delayed antiretroviral treatment (ART) initiation, reduced ART adherence, unsuppressed viremia, and mortality. Moreover, poor retention means effective ART cannot be leveraged to prevent further HIV transmission. The long-term goal is to improve the HIV care cascade by developing behaviorally-based interventions with broad applicability that can be executed with minimal cost and effort in community-based HIV care medical settings. The objective of this proposal, which is the next step in attaining the long-term goal and building on our successful R34 study, is to conduct a fully powered, randomized controlled trial (RCT) to assess the efficacy of a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care. The central hypothesis is that participants' informed disclosure of HIV status to members of their support system, facilitated through increased acceptance of HIV status early in medical care, will increase their longitudinal commitment to care. The aims of this proposal are: (1) To test, in a 2-arm RCT, the efficacy of the ABBT intervention on retention in care and virologic suppression (primary outcomes); and, ART adherence, disclosure of HIV status, perceived social support, HIV stigmatization (secondary outcomes), relative to an Enhanced-Treatment-as- Usual condition; and, (2) To examine the degree to which retention in HIV care and virologic suppression are mediated by (a) increased HIV acceptance (and decreased HIV experiential avoidance) and (b) increased willingness to disclose HIV status. The sample will consist of 270 HIV patients who are new to care, recruited from two large, geographically and ethnically diverse HIV medical care settings in Providence, R.I., and New Orleans, L.A. The approach is innovative in that it departs from the status quo by using brief acceptance-based psychotherapy techniques, delivered in-person and by telephone, to increase acceptance of HIV status and promoting careful and thoughtful serostatus disclosure as a specific mechanism to support retention and virologic suppression. Upon successful completion of the proposed R01 research, this study will contribute significant actionable data clarifying the impact and mediational mechanisms of ABBT on medical care retention and virologic suppression. Thus, it will lay the groundwork for the dissemination of a simple, low-cost intervention that can be integrated into usual HIV care.