Dindo Lilian, Moitra Ethan, Roddy McKenzie K, Ratcliff Chelsea, Markham Christine, Giordano Thomas
Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
J Clin Med. 2022 May 17;11(10):2827. doi: 10.3390/jcm11102827.
Roughly 40% of persons with HIV (PWH) are not consistently involved in HIV care in the US. Finding out-of-care PWH is difficult, but hospitalization is common and presents an opportunity to re-engage PWH in outpatient care. The aims of this study were to (1) develop an Acceptance and Commitment Therapy (ACT)-based intervention for hospitalized, out-of-care PWH who endorse avoidance-coping to improve HIV treatment engagement; (2) examine the intervention’s initial feasibility and acceptability; and (3) to revise the study protocol (including the intervention), based on stakeholder feedback, in preparation for a randomized controlled trial (RCT) comparing ACT to treatment as usual. Therapists and HIV care experts developed a four-session ACT-based intervention to be delivered during hospitalization. Fifteen hospitalized patients with poorly controlled HIV enrolled in the open trial, eight completed four sessions, two completed three sessions, and seven provided qualitative feedback. Patients universally liked the intervention and the holistic approach to mental health and HIV care. Refinements included repeating key concepts, including representative graphics, and translating to Spanish. Among the patients who attended ≥3 ACT sessions, 5/10 attended a HIV-care follow-up visit and 5/7 who had labs had a viral load <20 2-months post-intervention. Next steps include conducting a randomized clinical trial exploring the impact of the refined intervention to treatment as usual on retention in care and viral load. ClinicalTrials.gov Identifier: NCT04481373.
在美国，约40%的艾滋病毒感染者（PWH）未持续接受艾滋病毒治疗。找出未接受治疗的PWH很困难，但住院情况很常见，这为让PWH重新参与门诊治疗提供了契机。本研究的目的是：（1）为住院的、未接受治疗且采用回避应对方式的PWH开发一种基于接受与承诺疗法（ACT）的干预措施，以提高艾滋病毒治疗参与度；（2）检验该干预措施的初步可行性和可接受性；（3）根据利益相关者的反馈修订研究方案（包括干预措施），为一项将ACT与常规治疗进行比较的随机对照试验（RCT）做准备。治疗师和艾滋病毒护理专家开发了一种基于ACT的四节干预课程，在住院期间提供。15名艾滋病毒控制不佳的住院患者参加了开放试验，8名完成了四节课程，2名完成了三节课程，7名提供了定性反馈。患者普遍喜欢该干预措施以及心理健康和艾滋病毒护理的整体方法。改进措施包括重复关键概念（包括代表性图形）并翻译成西班牙语。在参加≥3节ACT课程的患者中，10人中有5人参加了艾滋病毒护理随访，7人中有5人在干预后2个月病毒载量<20。下一步包括进行一项随机临床试验，探索改进后的干预措施与常规治疗相比对治疗保留率和病毒载量的影响。ClinicalTrials.gov标识符：NCT04481373。
