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评估分析性治疗中断之前、期间和之后参与HIV治愈研究的参与者的社会心理经历:美国的一项纵向定性研究。

Evaluating the psychosocial experiences of participants in HIV cure research before, during, and after analytical treatment interruptions: A longitudinal qualitative study in the United States.

作者信息

Hill Miranda, Garcia Lidia Rodriguez, Nguyen Elizabeth, Korolkova Anastasia, Cohn Lillian, Rodriguez Antonio, Hoh Rebecca, Deeks Steven G, Peluso Michael J, Sauceda John A, Dubé Karine

机构信息

Division of Prevention Science, Department of Medicine, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, United States.

Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, United States.

出版信息

Soc Sci Med. 2025 Feb;366:117644. doi: 10.1016/j.socscimed.2024.117644. Epub 2024 Dec 25.

Abstract

The lack of socio-behavioral research on stress and psychosocial experiences among research participants who undergo analytical treatment interruption (ATI) in HIV cure studies underscores a critical gap in cure science. Existing literature acknowledges mixed and potentially adverse mental health impacts of ATIs among trial participants, but empirical insights before, during, and after clinical studies are scarce. We used longitudinal in-depth interviews with 11 participants in HIV cure-related research to explore their experiences with stress, coping, and psychological well-being before, during, and after an ATI. Our framework analyses of participant interviews suggest an evolving interplay between person- and environment-oriented factors that shape psychosocial well-being through multiple pathways. Key emergent themes surrounding stress, coping, and psychological adaptation before the ATI encompass the stress-protective effects of pill (in)significance, curiosity in natural immunological control, and perceived support, and trust with professional help networks comprised of providers and research staff. Themes that promoted positive secondary appraisals of stressors during ATIs involved generativity and meaning-based coping, and the stress-adaptive benefits of support-seeking and actualization. Finally, a theme exposing post-ATI stress revolved around the disappointment that participants noted feeling from needing to restart their HIV medications after the ATI and accepting the permanency of HIV and medications in their lives. Our findings emphasize the importance of building supportive and trusting relationships with research teams, and specify the stress-buffering mechanisms between emotional, informational, and appraisal support on ATI-related stress. Additionally, we outline multiple implications that advocate for the adoption of several precautionary measures in HIV cure research to mitigate psychosocial risks. By documenting the evolution of psychosocial experiences, we offer valuable insights to inform the design of future studies, ensuring their ethicality, acceptability, and inclusivity.

摘要

在艾滋病治愈研究中,对接受分析性治疗中断(ATI)的研究参与者的压力和社会心理经历缺乏社会行为学研究,这凸显了治愈科学中的一个关键空白。现有文献承认,试验参与者经历ATI会对心理健康产生复杂且可能不利的影响,但临床研究之前、期间和之后的实证见解却很匮乏。我们对11名参与艾滋病治愈相关研究的参与者进行了纵向深入访谈,以探讨他们在ATI之前、期间和之后的压力、应对方式及心理健康状况。我们对参与者访谈的框架分析表明,以人和环境为导向的因素之间存在不断演变的相互作用,这些因素通过多种途径塑造社会心理健康。ATI之前围绕压力、应对方式和心理适应的关键新出现主题包括药物(无)重要性的压力保护作用、对自然免疫控制的好奇心、感知到的支持,以及对由医护人员和研究人员组成的专业帮助网络的信任。在ATI期间促进对应激源进行积极二次评估的主题涉及繁衍感和基于意义的应对方式,以及寻求支持和自我实现的压力适应益处。最后,一个揭示ATI后压力的主题围绕着参与者在ATI后需要重新开始服用艾滋病毒药物并接受艾滋病毒和药物在其生活中的永久性时所感到的失望。我们的研究结果强调了与研究团队建立支持性和信任关系的重要性,并明确了情感、信息和评估支持对ATI相关压力的压力缓冲机制。此外,我们概述了多项影响,主张在艾滋病治愈研究中采取若干预防措施以减轻社会心理风险。通过记录社会心理经历的演变,我们提供了有价值的见解,为未来研究的设计提供参考,确保其伦理合理性、可接受性和包容性。

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