The BRIgHT Program: Building Resilience in HIV Together

Study Overview
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Brief Summary
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This is the second phase of a two-part study. In the first phase (Protocol ID: R34AT009170), the investigators refined and piloted the Relaxation Response Resiliency (3RP) intervention for women age 50 and over who are living with HIV, a group especially burdened by stressors related both to aging and to living with chronic disease. In this part of the study, the investigators will use data from the first phase to further adapt the intervention manual, and test the final product via a small randomized controlled trial in the same population.

Detailed Description
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Overview. This is the second phase of a two-part study. In the first phase (Protocol ID: R34AT009170), the investigators adapted an existing resiliency intervention, the Relaxation Response Resiliency Program (3RP), to the needs of women ages 50 and over who are living with HIV. The investigators conducted preliminary testing of the refined group intervention via an open pilot study (N=13 enrolled) across two sites, MGH and Boston Medical Center), and conducted individual exit interviews to solicit feedback on the intervention. Based on these qualitative data, as well as qualitative work conducted previously with this population, the goal of this phase of the project is to conduct a small, randomized pilot of the intervention in groups of up to 10 women with HIV (total N=up to 60) to assess feasibility and acceptability of all study procedures. Study Procedures. Participants will be women living with HIV (N=up to 60) age 50 or over, who are recruited via flyers and provider referral from Boston area hospitals and health care settings, as well as community organizations serving individuals living with HIV. Once an individual expresses interest in the study, they will be screened by a study staff member, either by phone or in person, in order to assess study eligibility. Eligible and interested individuals will be invited to sign informed consent and complete an in-person baseline assessment. Participants will be randomized to either a 10-week intervention group (adapted 3RP intervention) or a 10-week control group (supportive psychotherapy program). Participants will then complete a post-treatment assessment, an individual in-depth exit interview to provide feedback on their experience in the study, and a 3-month follow-up assessment. Data from this second phase of the study will inform the eventual development of a full-scale randomized controlled trial. Adapted 3RP Intervention. Once randomized into the intervention condition, participants will complete 10, 90-minute weekly group sessions of the adapted 3RP intervention. Sessions will focus on developing an understanding of stress sources and physiology, and on developing a regular practice of eliciting the relaxation response (RR) and learning cognitive behavioral and positive psychology skills to enhance resiliency to long-term stress. Participants will be encouraged to practice skills (RR practice, thoughts records to learn adaptive thinking) between group sessions. Supportive Psychotherapy Control Program. The control condition will be a supportive therapy program that is matched to the intervention for number and length of sessions. Basic principles of supportive psychotherapy will be followed, and the interventionist will facilitate discussion around what it is like to live with HIV as an aging woman.

Official Title
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Developing a Resilience Intervention for Older, HIV-Infected Women

Conditions
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Resilience, Psychological

Intervention / Treatment
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* Behavioral: Adapted 3RP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: biologically born women who endorse a female identity living with HIV/AIDS age 50 or older English-speaking Exclusion Criteria: presence of an active (i.e. untreated) and interfering psychiatric disorder (e.g., bipolar disorder, schizophrenia, substance abuse) have participated in a structured cognitive behavioral therapy and/or a mind-body intervention in the past year

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention: 10 weekly sessions of the adapted Relaxation Response Resiliency Program (3RP) Control: 10 weekly sessions of a supportive psychotherapy program
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group: Adapted 3RP<br>The intervention condition will consist of the 10-week adapted 3RP intervention. | Behavioral: Adapted 3RP<br>* The 3RP blends stress management principles, cognitive behavioral therapy, and positive psychology. The 3RP focuses on 3 major areas: (1) eliciting the relaxation response; (2) increasing stress awareness; and (3) promoting adaptive strategies. The adapted 3RP intervention consists of 10, 90-minute weekly group sessions. Content specific to older women living with HIV, including self-compassion exercises, was added to the intervention in the first phase of this study (open pilot).<br>|
| No Intervention: Control Group: Supportive Psychotherapy<br>The control condition will be a 10-week supportive therapy program. Visits include supportive psychotherapy to address stressful or difficult topics related to aging as a woman living with HIV. The program was developed to approximate the most frequent mental health counseling provided to adults with HIV at the community level. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of Study Procedures, as Assessed by Number of Individuals Screened and Eligible for Participation in the Study | Investigators assessed feasibility of study procedures by tracking the number of potential participants screened and eligible for participation. These metrics were assessed together with the number of eligible individuals enrolled, and the number of assessments completed in order to provide a comprehensive understanding of the feasibility of this study. | Assessed at screening (pre-baseline) | 
| Feasibility of Study Procedures, as Assessed by Number of Individuals Enrolled and Number of Assessments and Sessions Completed by Enrolled Individuals. | Investigators assessed feasibility of study procedures by tracking the number of eligible participants enrolled, and the number of treatment, assessment, and make-up sessions completed by all enrolled participants. These metrics were assessed together with the number of individuals screened and eligible in order to provide a comprehensive understanding of the feasibility of this study. | Assessed up to 6 months post-baseline | 
| Feasibility of Study Procedures, as Assessed by Time Required for Screening and Enrollment | Investigators assessed feasibility of study procedures by tracking the time it takes to screen and enroll participants, as measured by the number of months it took to recruit, screen, and schedule a baseline assessment for all 44 participants, compared to the number of months we estimated it would take to enroll our target number of participants at the outset of the study (11 months). These metrics were assessed in order to provide a comprehensive understanding of the feasibility of this study. | Assessed after completion of all baseline assessments | 
| Feasibility of Study Procedures, as Assessed by Time Required to Complete Study Procedures | Investigators assessed feasibility of study procedures by tracking the time it takes for participants to complete each assessment. These metrics were assessed in order to provide a comprehensive understanding of the feasibility of this study. | Assessed up to 6 months post-baseline | 
| Feasibility as Assessed by Reasons for Declining Enrollment | Includes the number of individuals who were eligible (N=61), but declined to enroll and those reasons for declining. | Assessed at screening (pre-baseline) | 
| Feasibility as Assessed by Reasons for Enrolling But Not Taking Part in Group Sessions | Includes the number of individuals who enrolled, but did not take part in group sessions (N=2) and the reasons for not participating. | Assessed up to 3 months post-baseline | 
| Feasibility as Assessed by Reasons for Withdrawing From the Study | Includes the number of individuals who withdrew from the study, despite participating in group sessions (N=7), and the reasons for withdrawing. | Assessed up to 6 months post-baseline | 
| Feasibility as Assessed by Participants Lost to Follow-Up | Includes the number of individuals who were lost to follow-up and unable to be traced (N=5). | Assessed up to 6 months post-baseline | 
| Acceptability of Study Procedures, as Assessed by the Client Satisfaction Questionnaire | Investigators assessed acceptability at the post-treatment visit using the eight-item Client Satisfaction Questionnaire (CSQ-8), a measure of how much an individual values a treatment. Items are summed to create an overall score; scores range from 8 to 32, with higher scores indicating higher satisfaction. Excellent acceptability was defined a priori as CSQ-8 scores between 26 and 32, and good acceptability was defined a priori as CSQ-8 scores between 20 and 25. | Assessed up to 6 months post-baseline | 
| Acceptability of Study Procedures, as Assessed by the Perception of Study Assessments Questionnaire | Investigators assessed acceptability at the post-treatment visit by asking participants about their perceptions of the burden of the study assessment battery on a scale from 1 (no/minimal burden) to 10 (too much of a burden). Items are summed to create an overall score; scores range from 1 to 10, with lower scores indicating higher satisfaction. | Assessed up to 6 months post-baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Resilience, Women, HIV/AIDS