Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

中文翻译：

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基于循证咨询的个性化网络注意力培训，以解决 HIV 治疗依从性和心理困扰：探索性队列研究

背景： HIV 感染者的情绪、创伤和压力相关疾病的患病率比没有感染病毒的人要高得多。艾滋病毒治疗依从性差和心理困扰加剧与这些疾病相关的症状有关。目标：这项探索性试点研究的目的是制定和实施一项干预措施，将基于网络的个性化注意力培训与循证咨询相结合，以促进 HIV 治疗的依从性并减少 HIV 感染者的心理困扰。该研究针对与男性发生性关系的非裔美国人和拉丁裔年轻男性，这两个美国人群在 HIV 治疗结果方面继续存在差异。方法：主要通过洛杉矶健康和社会服务提供者的推荐以及社交媒体上的帖子招募抑郁症状升高和抗逆转录病毒治疗依从性不佳的研究参与者。参加为期 4 周的干预的参与者每周接受咨询，以通过他们的个人移动设备或计算机进行依从性和日常访问基于网络的注意力培训。结果：在开始干预的 14 名参与者中，12 名 (86%) 完成了所有课程和研究程序。使用前测-后测设计，结果表明依从性、抑郁症状和注意力处理有显着改善。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% 下降到干预完成时的 25% ( P =.02, phi = 0.68)。通过 9 项患者健康问卷 (PHQ-9) 测量的平均抑郁症状显着减少了 36% ( P =.002, Cohen d =1.2)。此外，参与者对注意力训练期间呈现的所有类型刺激配对的注意力处理速度显着提高（P = .01 和P=.02) 并且伴随着从 0.78 到 1.0 的大效应量。结论：我们的研究结果支持基于网络的注意力训练结合咨询提高心理困扰患者抗逆转录病毒治疗依从性的可行性。未来的研究应该包括更大的样本、一个对照组和更长期的随访。