Houston Eric, Fadardi Javad Salehi, Harawa Nina T, Argueta Chris, Mukherjee Sukrit
Claremont Graduate University, Claremont, CA, United States.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
JMIR Ment Health. 2021 Jan 28;8(1):e18328. doi: 10.2196/18328.
The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders.
The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes.
Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers.
Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0.
Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.
与情绪、创伤及应激源相关的疾病在艾滋病病毒感染者中的患病率，相较于未感染病毒的个体，高得不成比例。对艾滋病治疗的依从性差以及心理困扰加剧，都与这些疾病相关的症状存在关联。
这项探索性试点研究的目的是开发并实施一种干预措施，该措施将个性化的基于网络的注意力训练与循证咨询相结合，以促进艾滋病病毒感染者坚持接受治疗，并减轻他们的心理困扰。该研究的目标人群是与男性发生性行为的非裔美国人和拉丁裔青年男性，这两类人群在美国的艾滋病治疗结果方面仍存在差异。
主要通过洛杉矶卫生和社会服务提供者的推荐以及社交媒体上的招募信息，招募了抑郁症状较重且抗逆转录病毒治疗依从性欠佳的研究参与者。参加为期4周干预的参与者每周接受一次关于依从性的咨询，并通过个人移动设备或电脑每天接受基于网络的注意力训练。
在开始干预的14名参与者中，12名（86%）完成了所有疗程和研究程序。采用前测-后测设计，结果表明在依从性、抑郁症状和注意力处理方面有显著改善。总体而言，报告抗逆转录病毒治疗依从性低的参与者比例从基线时的42%降至干预结束时的25%（P = 0.02，phi = 0.68）。用9项患者健康问卷（PHQ - 9）测量的平均抑郁症状大幅减少了36%（P = 0.002，Cohen d = 1.2）。此外，参与者在注意力训练期间对所有类型刺激配对的注意力处理速度显著提高（P = 0.01和P = 0.02），且效应量较大，范围从0.78到1.0。
我们的研究结果支持了将基于网络的注意力训练与咨询相结合，以提高心理困扰患者抗逆转录病毒治疗依从性的可行性。未来的研究应纳入更大的样本、一个对照组以及更长期的随访。
