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Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study
Adaptation of a Transdiagnostic Psychotherapy for People with HIV to Improve Mental Health and HIV Treatment Engagement: Qualitative and Formative Research Following Principles of an Adaptation Framework
Doyanne Darnell;
Minu Ranna-Stewart;
Christina Psaros;
Teresa R Filipowicz;
LaKendra Grimes;
Savannah Henderson;
Mariel Parman;
Kathy Gaddis;
Bradley Neil Gaynes;
Michael J Mugavero;
Shannon Dorsey;
Brian W Pence
ABSTRACT
Background:
Treatments that address behavioral health comorbidities and HIV-related stigma, which are key barriers to successful HIV treatment engagement, and that are designed to be readily implemented in HIV care settings are needed.
Objective:
We present the process for adapting a transdiagnostic cognitive-behavioral psychotherapy, the Common Elements Treatment Approach, for people with HIV (PWH) receiving HIV treatment at a Southern U.S. HIV clinic.
Methods:
We applied principles of the ADAPT-ITT model and included collaborative and participatory methods to incorporate opinions and perspectives of diverse stakeholders. We conducted three focus groups; one with clinic social workers (n = 3) and two with male (n = 3) and female (n = 4) patients. The adaptation also included integrating a component based on Life-Steps, a cognitive-behavioral brief intervention to support patients in their engagement with HIV treatment. We trained counselors on the adapted protocol and are currently conducting a pilot clinical trial to examine the acceptability and feasibility of CETA-PWH for future evaluation in a full-scale trial.
Results:
The focus group with social workers indicated the adapted therapy made conceptual sense and addressed common behavioral health concerns as well as practical and cognitive-behavioral barriers to HIV treatment engagement. Key considerations for CETA-PWH generated from social worker and patient focus groups were related to stigma, socioeconomic stress and instability experienced by the clinic population and the use of substances by some patients that can thwart the stability needed to engage in care. CETA-PWH is designed to address these barriers to HIV treatment.
Conclusions:
Our team successfully utilized principles of the ADAPT-ITT framework to adapt CETA for PWH. The resulting brief, manualized therapy is designed to help patients build skills that promote HIV treatment engagement as well as reduce symptoms of common behavioral health conditions that themselves are known to thwart HIV treatment engagement.
Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study