Establishing the feasibility, acceptability and preliminary efficacy of a multi-component behavioral intervention to reduce pain and substance use and improve physical performance in older persons living with HIV.

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
Author Information:
1Division of Geriatrics, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America. Electronic address: alisonmoore@ucsd.edu.
2Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, United States of America.
3Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences and School of Nursing, University of California, Los Angeles, CA, United States of America.
4Division of Geriatrics, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America.
5Silberman School of Social Work, Hunter College at City University of New York, New York, NY, United States of America.
6APAIT, A Division of Special Services for Groups, Los Angeles, CA, United States of America.
7Center 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.
8Division 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

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