Development of An Acceptance Based PrEP Intervention ( ACTPrEP ) to Engage Young Black MSM in the South Utilizing the Adaptome Model of Intervention Adaptation.

Autor: Arnold T; Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903.; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906., Gaudiano BA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906., Barnett AP; Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903.; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906., Elwy AR; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906.; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA., Whiteley L; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906., Giorlando KK; Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903., Rogers BG; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906.; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02903., Ward LM; Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi USA 39217., Leigland A; Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903., Brown LK; Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903.; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906.
Jazyk: angličtina
Zdroj: Journal of contextual behavioral science [J Contextual Behav Sci] 2023 Apr; Vol. 28, pp. 60-70. Date of Electronic Publication: 2023 Mar 10.
DOI: 10.1016/j.jcbs.2023.03.009
Abstrakt: Objectives: HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses.
Methods: Twenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed.
Results: Patients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP .
Conclusions: Interview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals' willingness to initiate and maintain PrEP care.
Competing Interests: Dr. Rogers receives research funding from Gilead Sciences #IN-US-276-5463.
Databáze: MEDLINE
Externí odkaz: