Author: Moore AA1, Lake JE2, Glasner S3, Karlamangla A4, Kuerbis A5, Preciado D4, Jenkins J4, Dominguez BX4, Candelario J6, Liao DH4, Tang L7, Reid MC8
Affiliation: <sup>1</sup>Division of Geriatrics, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America. Electronic address: alisonmoore@ucsd.edu.
<sup>2</sup>Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, United States of America.
<sup>3</sup>Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences and School of Nursing, University of California, Los Angeles, CA, United States of America.
<sup>4</sup>Division of Geriatrics, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America.
<sup>5</sup>Silberman School of Social Work, Hunter College at City University of New York, New York, NY, United States of America.
<sup>6</sup>APAIT, A Division of Special Services for Groups, Los Angeles, CA, United States of America.
<sup>7</sup>Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, United States of America.
<sup>8</sup>Division of Geriatrics and Palliative Care, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
Conference/Journal: J Subst Abuse Treat.
Date published: 2019 May
Other:
Volume ID: 100 , Pages: 29-38 , Special Notes: doi: 10.1016/j.jsat.2019.02.003. Epub 2019 Feb 14. , Word Count: 323
Older persons living with HIV (PLWH), often defined as age 50 years and older, are a rapidly growing population, with high rates of chronic pain, substance use, and decreased physical functioning. No interventions currently exist that address all three of these health outcomes simultaneously. An 8-week behavioral intervention combining cognitive-behavioral therapy and tai chi reinforced with text messaging (CBT/TC/TXT) was developed and pilot tested in a community-based AIDS service organization with substance using PLWH aged 50 years and older who experienced chronic pain. Fifty-five participants were enrolled in a three arm randomized controlled trial that compared the CBT/TC/TXT intervention (N = 18) to routine Support Group (SG) (N = 19) and Assessment Only (AO) (N = 18) to assess the intervention's feasibility, acceptability and preliminary efficacy to reduce pain and substance use and improve physical performance. Participants were assessed at baseline, treatment-end (week 8) and week 12. Feasibility and acceptability indicators showed moderate levels of participant enrollment (62% of those eligible), excellent 12-week assessment completion (84%) and high attendance at CBT and tai chi sessions (>60% attended at least 6 of 8 sessions). Efficacy indicators showed within-group improvements from baseline to week 12 in the CBT/TC/TXT group, including all four substance use outcomes, percent pain relief in the past 24 h, and in two physical performance measures. Observed between-group changes included greater reductions in days of heavy drinking in the past 30 days for both CBT/TC/TXT (19%) and SG (13%) compared to the AO group. Percent pain relief in the past 24 h improved in the CBT/TC/TXT group relative to SG, and the CBT/TC/TXT's physical performance score improved relative to both the SG and AO groups. Findings demonstrate that the CBT/TC/TXT intervention is feasible to implement, acceptable and has preliminary efficacy for reducing substance use and pain and improving physical performance among a vulnerable population of older PLWH.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS: HIV; Older; Pain; Physical performance; Randomized clinical trial; Substance use
PMID: 30898325 DOI: 10.1016/j.jsat.2019.02.003