PROVIDENCE, R.I. – The Centers for Behavioral and Preventive Medicine at The Miriam Hospital has received a $146,000 research project grant from The National Center for Complementary and Integrative Health to explore whether telephone-delivered mindfulness training (MT) can help individuals living with HIV better cope with stress, anxiety and depression; increase their adherence to antiretroviral therapy (ART); and promote healthy behaviors. The Miriam Hospital is the first facility in the nation to evaluate phone-delivered MT for people living with HIV.
A form of meditation, mindfulness is an awareness of the present and moment-to-moment activities. It is a fundamental ability of the mind, but studies have shown that it is a teachable skill and mindfulness levels increase with training.
"Mindfulness has been proven effective in lessening anxiety, depression and physical symptoms associated with many medical conditions ranging from cancer to rheumatoid arthritis and fibromyalgia," said Michael Carey, Ph.D., lead researcher and director, The Centers for Behavioral and Preventive Medicine at The Miriam Hospital. "However, few studies have examined mindfulness training for those with HIV."
People living with HIV are strongly advised to adhere to ART to increase longevity and decrease HIV-related deaths and infectiousness, their ability to spread infection. They are also strongly advised to avoid risky sexual behaviors to avoid HIV super-infection and other sexually transmitted infections and to reduce the likelihood of transmitting HIV to an uninfected partner. Like most patients living with a chronic illness, they are also advised to get regular physical activity and sleep, eat well, and avoid substance use. However, life stresses make it challenging for people with HIV to follow such medical recommendations. Mindfulness training is designed to help people better manage life stress so that they are better able to follow medical recommendations. The benefits of phone-based MT include fewer barriers such as transportation and parking that can undermine participation in group-based MT training. It also allows for individualization of MT – as compared to group instruction – increasing the likelihood that patients will continue with and benefit from the practice. Additionally, phone-delivered MT reduces the burden on HIV clinics where space is often limited and reduces the staffing burden at clinical sites because instruction is not restricted to a clinical site.
Consisting of several phases, this research project will determine the feasibility and acceptability of phone-based MT and explore its effectiveness for improving ART adherence and promoting healthy behaviors. First, a series of focus groups will be conducted with up to 30 individuals including those living with HIV, HIV care providers and HIV advocates. They'll share their perspectives about what is needed to expand the care provided at The Samuel and Esther Chester Immunology Center at The Miriam Hospital, and help inform new immunology center health programs that are in development. The information will be used to refine related programs and research materials.
Next, a clinical trial will assess 50 immunology center patients who will be provided with one of two health improvement programs. Both programs will be designed to address the health needs of people living with HIV. One will feature mindfulness meditation and the second program will feature broader health promotion programs with specific content determined following completion of the focus groups. The study phases will include an individual baseline assessment and individual intervention conducted via phone, as well as a three-month follow up. At the time of enrollment and again over the subsequent three months, all patients will complete surveys and provide specimens to measure the effectiveness of both programs.
"Preliminary research suggests that traditional mindfulness training can help people with HIV cope more effectively with stress, but it has limitations and there is little to no information available about the possible effect of MT on ART adherence and other health behaviors," said Carey. "Additionally, traditional MT has typically been delivered in formats that make it impossible for people with HIV to participate given their disproportionately low income and often their lack of necessary resources. We believe phone-based MT can make a significant difference in the lives and quality of life of people living with HIV."
In addition to his primary affiliation at The Miriam Hospital, Carey is a professor of psychiatry and human behavior at the Alpert Medical School of Brown University. Other researchers in the study include Elena Salmoirago-Blotcher, M.D., Ph.D., a research scientist at The Miriam Hospital Centers for Behavioral and Preventive Medicine and an assistant professor of medicine and assistant professor of epidemiology at the Alpert Medical School of Brown University and Brown's School of Public Health; and Aadia Rana, M.D., an internal medicine and infectious diseases physician at The Miriam Hospital and an assistant professor of medicine at the Alpert Medical School of Brown University.
About The Miriam Hospital
The Miriam Hospital is a 247-bed, not-for-profit teaching hospital affiliated with The Warren Alpert Medical School of Brown University. It offers expertise in cardiology, oncology, orthopedics, men's health, and minimally invasive surgery and is home to the state's first Joint Commission-certified Stroke Center and robotic surgery program. The hospital, which received more than $23 million in external research funding last year, is nationally known for its HIV/AIDS and behavioral and preventive medicine research, including weight control, physical activity and smoking cessation. Named 2015-16 best regional hospital in Rhode Island and the Providence metro area by U.S. News & World Report, The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services five times and is a founding member of the Lifespan health system. Follow us on Facebook (http://www.facebook.com/miriamhospital), Twitter (@MiriamHospital) and Pinterest (http://www.pinterest.com/MiriamHospital).