Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV

综合远程医疗干预可减少艾滋病毒感染者的慢性疼痛和不健康饮酒

• 批准号: 10304670
• 负责人: TIBOR P. PALFAI
• 金额: $ 36.81万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10304670
• 关键词: AIDS/HIV problem; Address; Adherence; Aftercare; Age; Alcohol consumption; Alcohols; Arthritis; Behavior; Behavior Therapy; Behavioral; Boston; Caring; Cellular Phone; Child Care; Cognitive; Cognitive Therapy; Collaborations; Complication; Computer software; Distant; Dropout; Ecological momentary assessment; Economics; Face; Frequencies; HIV; HIV risk; Health; Health Personnel; Heavy Drinking; Intervention; Interview; Measures; Mediating; Mediator of activation protein; Medical; Methods; Modality; Morbidity - disease rate; Motivation; Neuropathy; Online Systems; Outcome; Pain; Pain interference; Pain management; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacology; Physical Capacity; Physical Function; Population; Procedures; Process; Psyche structure; Questionnaires; Randomized Controlled Trials; Recording of previous events; Research Project Grants; Resources; Risk; Risk-Taking; Severities; Structure; Symptoms; Technology; Testing; Time; Transportation; Treatment Efficacy; Videoconferencing; Work; acceptability and feasibility; age related; alcohol intervention; alcohol misuse; alcohol related consequences; alcohol research; alcohol response; alcohol use disorder; anxiety symptoms; base; brief advice; chronic pain; chronic pain management; community setting; comorbidity; compliance behavior; daily functioning; depressive symptoms; drinking; efficacy testing; environmental stressor; follow-up; functional outcomes; functional status; healthcare community; improved; indexing; insight; intervention effect; medical specialties; mental function; mortality; pain outcome; phosphatidylethanol; primary outcome; remote intervention; social stigma; substance use; technology development; telehealth; therapy design; web site

PROJECT SUMMARY/ABSTRACT Unhealthy drinking and chronic pain are common co-occurring conditions among people living with HIV (PLWH) each of which negatively influences physical and mental functioning, HIV-related outcomes, and one another. Health care providers face a number of challenges to addressing these frequently co-occurring conditions for PLWH including restricted time and resources, limitations of pharmacological treatments to adequately treat both conditions (particularly among those with other co-occurring medical conditions or substance use histories), and poor patient adherence to recommended non-pharmacological treatments. Although there are empirically-supported behavioral approaches to address the full spectrum of each of these conditions, they often require multiple session, in-person interventions. Such requirements are burdensome to PLWH, who may face stigma and considerable economic challenges regarding transportation, child-care, and missed work. These challenges are compounded when considering treatments for multiple conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be easily utilized by patients. In our prior work, we have developed an integrated behavioral video telehealth intervention designed to reduce unhealthy alcohol use and chronic pain among PLWH. This intervention, Motivational and Cognitive Behavioral Treatment for the Management of Alcohol Use and Pain (MCBMAP) is a 7-session integrated intervention that is delivered through telehealth and supplemented with materials available on a website. The intervention, which was tailored for PLWH based on qualitative interviews, has been shown to have high patient acceptability and be readily delivered through smartphones. The current study seeks to test the efficacy of this intervention for reducing unhealthy drinking and chronic pain in a fully-scaled, randomized controlled trial among PLWH that compares MCBMAP to a Brief Advice and Information condition at 6-month outcomes. In addition, this project will examine moderators and mediators of intervention through self-report questionnaires and through the use of ecological momentary assessment (EMA) conducted before and after treatment. These EMA methods will allow us to examine how the processes through which the intervention may reduce unhealthy drinking and pain as well as provide insight into the association between pain, unhealthy drinking, and functional outcomes in this population.

项目概要/摘要 不健康饮酒和慢性疼痛是艾滋病毒感染者常见的并发疾病 (PLWH) 其中每一项都会对身心功能、艾滋病毒相关结果产生负面影响，并且其中一项 其他。医疗保健提供者在解决这些经常同时发生的问题时面临着许多挑战 感染者的条件包括时间和资源有限、药物治疗的局限性 充分治疗这两种疾病（特别是那些同时患有其他疾病或 物质使用史），以及患者对推荐的非药物治疗的依从性差。 尽管有经验支持的行为方法可以解决所有这些问题 条件下，他们通常需要多次会议、面对面的干预。这样的要求对于 艾滋病病毒感染者可能在交通、儿童保育和卫生方面面临耻辱和巨大的经济挑战 错过了工作。当考虑多种病症的治疗时，这些挑战变得更加复杂。给定 艾滋病病毒感染者中慢性疼痛和酗酒的发生率及其对日常功能的综合影响和 艾滋病毒的结果和现有治疗的局限性，综合治疗将带来相当大的好处 以患者可以轻松使用的方式解决这些共病的行为方法。 在我们之前的工作中，我们开发了一种综合行为视频远程医疗干预措施，旨在减少 感染者中不健康的饮酒和慢性疼痛。这种干预，动机和认知 管理酒精使用和疼痛的行为治疗 (MCBMAP) 是一个为期 7 个疗程的综合治疗 通过远程医疗提供的干预措施并辅以网站上提供的材料。这 基于定性访谈为艾滋病患者量身定制的干预措施已被证明具有很高的效果 患者的可接受性，并且可以通过智能手机轻松交付。目前的研究旨在测试功效 这项干预措施旨在减少不健康饮酒和慢性疼痛，这是一项全面、随机对照的研究 在 PLWH 中进行的试验，将 MCBMAP 与 6 个月结果的简要建议和信息条件进行比较。 此外，该项目将通过自我报告来审查干预的主持人和调解员 问卷调查并通过使用前后进行的生态瞬时评估（EMA） 治疗。这些 EMA 方法将使我们能够检查干预的过程如何 可以减少不健康饮酒和疼痛，并深入了解疼痛与不健康饮酒之间的关联 该人群的饮酒和功能结果。