Implementing Evidence-Based Treatment for Common Mental Disorders in HIV Clinics in Ukraine

项目总结 从2010年到2020年，东欧报告说，新的成人艾滋病毒感染增加了72%，这是 全球最高的增长速度。在东欧国家中，乌克兰的艾滋病毒疫情是其中之一 在最大的国家中，有近26万艾滋病毒携带者(PWH)。然而，在2020年，只有54%的乌克兰PWH 正在接受抗逆转录病毒治疗(ART)，只有51%的人被病毒抑制。这些不太理想的艾滋病毒护理 连续性结局部分归因于精神障碍，精神障碍在PWH中更为普遍 普遍(特别是在乌克兰)，并与ART依从性下降和不良有关 参与艾滋病毒护理。尽量减少精神健康受损对艾滋病毒结果的不利影响，创造 增加以证据为基础的精神卫生保健的途径是一项关键的公共卫生需求。长的- 该申请者的学期目标是发展测试跨诊断精神卫生干预的专业知识，以 改善乌克兰威尔斯亲王医院的艾滋病毒结果。此K23应用程序的目标是改编通用 元素治疗方法(CETA)，通过纳入单次生命步骤ART坚持 干预，以减少乌克兰PWH中的抑郁、焦虑和创伤后应激症状。 需要检验的中心假设是，调整后的CETA加上生命步骤干预将改善HIV 以及乌克兰威尔斯亲王医院的心理健康状况。支持这一申请的强有力的初步数据 显示乌克兰的社区心理学家认为他们没有足够的知识来提供精神上的 健康治疗，但对学习CETA等短期治疗仍有浓厚兴趣。为了测试 根据中心假设，提出了以下具体目标：(1)界定相关的临床和背景 使CETA适用于艾滋病毒诊所分娩和将生命步骤纳入现有方案的因素；(2) 确定调整后的CETA PLUS生命步骤的可行性、可接受性和初步疗效 干预；以及(3)估计调整后的CETA加生活步骤的潜在调解人和调解人 干预。这项K23考试的预期结果是，申请人将获得三项所需的专业知识 艾滋病毒和心理健康的关键培训领域、随机临床试验设计和纵向数据 进行必要的分析，以实现研究的独立性。关键的创新是，这项研究将是第一个 将CETA与LIFE-STEPS结合起来，评估其在低收入或中等收入国家的初步效果。 由此产生的初步数据还将支持一项引人注目的R01申请，该申请将于年第4年提交 K23奖励期，测试调整后的CETA加上Life-Steps干预在全功率、多地点的效果 在乌克兰留学。如果成功，拟议的研究将通过提供一种 威斯康星医院心理健康问题的循证干预治疗 应对东欧威斯康星医院人群的双重心理健康危机和艾滋病毒流行。

PROJECT SUMMARY From 2010-2020, Eastern Europe reported a 72% increase in new adult HIV infections, representing the highest rate of increase globally. Among the Eastern European countries, the HIV epidemic in Ukraine is one of the largest, with nearly 260,000 people with HIV (PWH). Nevertheless, in 2020, only 54% of Ukrainian PWH were on antiretroviral therapy (ART), and only 51% were virally suppressed. These suboptimal HIV care continuum outcomes are partially attributable to mental disorders, which are more prevalent among PWH generally (and in Ukraine specifically) and have been linked to decreased ART adherence and poor engagement in HIV care. To minimize the adverse effects of impaired mental health on HIV outcomes, creating a pathway to increase access to evidence-based mental health care is a critical public health need. The long- term goal of this applicant is to develop expertise in testing transdiagnostic mental health interventions to improve HIV outcomes among PWH in Ukraine. The objective of this K23 application is to adapt the Common Elements Treatment Approach (CETA), by incorporating the single-session Life Steps ART adherence intervention, to reduce symptoms of depression, anxiety, and posttraumatic stress among PWH in Ukraine. The central hypothesis to be tested is that the adapted CETA plus Life-Steps intervention will improve both HIV and mental health outcomes among PWH in Ukraine. The strong preliminary data supporting this application shows that community psychologists in Ukraine feel they do not have adequate knowledge to deliver mental health treatment but nonetheless have strong interest in learning short-term treatments such as CETA. To test the central hypothesis, the following specific aims are proposed: (1) To define relevant clinical and contextual factors for adapting CETA for delivery in HIV clinics and for integrating Life-Steps into the existing protocol; (2) To determine the feasibility, acceptability, and preliminary efficacy of the adapted CETA plus Life-Steps intervention; and (3) To estimate potential mediators and moderators of the adapted CETA plus Life-Steps intervention. The expected outcome of this K23 is that this applicant will gain the expertise needed in the three critical training areas of HIV and mental health, design of randomized clinical trials, and longitudinal data analysis necessary to achieve research independence. The key innovation is that this study will be the first to combine CETA with Life-Steps and evaluate its preliminary efficacy in a low- or middle-income country setting. The resulting preliminary data will also support a compelling R01 application, to be submitted in year 4 of the K23 award period, to test the adapted CETA plus Life-Steps intervention in a fully-powered, multi-site efficacy study in Ukraine. If successful, the proposed research will have significant public health impact by providing an evidence-based intervention for treating mental health problems among PWH, with attendant implications for addressing the dual mental health crisis and HIV epidemic in PWH populations throughout Eastern Europe.