Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA)

赞比亚阿拉巴马州艾滋病毒酒精合并症计划 (ZAMBAMA)

• 批准号: 10303936
• 负责人: Karen L Cropsey
• 金额: $ 117.75万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10303936
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Africa South of the Sahara; Alabama; Alcohol consumption; Alcohols; Anxiety; Apache; Arizona; Back; Businesses; COVID-19 pandemic; Caring; Clinic; Clinical; Clinical effectiveness; Cognitive Therapy; Collaborations; Communities; Complex; Continuity of Patient Care; Data; Data Analyses; Data Collection; Data Element; Deep South; Disadvantaged; Educational Intervention; Elements; Enrollment; Epidemic; Evidence based intervention; Face; Funding; Gap Junctions; Gender; Geographic Locations; HIV; Health Personnel; Human Resources; Incidence; Infectious Diseases Research; Interpersonal Violence; Intervention; Knowledge; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Monitor; National Institute on Alcohol Abuse and Alcoholism; Outcome; Pain; Participant; Patients; Persons; Population Heterogeneity; Prevalence; Prevention; Professional counselor; Protocols documentation; Provider; Psychologist; Public Sector; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Research; Research Personnel; Research Project Grants; Resources; Rural Population; Southern Africa; Structure; Supervision; Telemedicine; Testing; Training; Translating; Treatment outcome; Underserved Population; United States; United States National Institutes of Health; Viral; Zambia; addiction; alcohol comorbidity; alcohol misuse; antiretroviral therapy; base; behavioral health; behavioral health intervention; brief alcohol intervention; brief intervention; common treatment; community clinic; comorbidity; compare effectiveness; contextual factors; cost; cost effective; data harmonization; design; effectiveness testing; implementation determinants; improved; low and middle-income countries; mortality; peer; population based; post-traumatic stress; post-traumatic symptoms; programs; reduce symptoms; response; screening; substance use; suicidal risk; synergism; therapy adherence; treatment as prevention; treatment effect; trial design

Project Summary/Abstract The overall aims of the Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA) are to (Aim 1) test the effectiveness of a transdiagnostic model, Common Elements Treatment Approach (CETA), to reduce unhealthy alcohol use and improve HIV clinical outcomes in under-resourced HIV clinics, (Aim 2) evaluate the mechanisms through which CETA impacts HIV outcomes, (Aim 3) investigate whether the treatment effect of CETA varies by clinical (e.g., presence of comorbidities), demographic (e.g., gender) and/or contextual factors (e.g., Zambia, Alabama), and (Aim 4) examine implementation factors, including cost, related to integrated delivery of alcohol reduction interventions to disadvantaged people with HIV and unhealthy alcohol use at front- line HIV clinics. The P01’s central theme is that, among people with HIV and unhealthy alcohol use, integrated screening and treatment of common behavioral and mental health comorbidities will lower unhealthy alcohol use and improve HIV treatment outcomes. ZAMBAMA will be implemented by a collaborative team that brings together groups of established and young investigators working to address scientific gaps at the nexus of HIV, substance use, and mental illness in priority geographical areas in the global HIV response: sub-Saharan Africa and the Southern U.S. Together, the team will implement two randomized controlled clinical trials in adults with HIV and unhealthy alcohol use to evaluate CETA’s effects on alcohol use, the HIV care continuum (antiretroviral therapy adherence, engagement and retention in HIV care, viral suppression), and common mental health and substance use comorbidities. Project 1 (CETA HIV Alcohol Reduction Trial in Zambia - CHARTZ) will be implemented at public sector primary HIV clinics in Zambia where existing HIV ‘peer educators’ (i.e., lay counselors) will be trained to provide an alcohol brief intervention (BI) and CETA to participants at in-person sessions. Project 2 (Telemedicine for Unhealthy Alcohol Use in Persons Living with HIV using CETA - TALC) will enroll participants receiving HIV care at community Ryan White HIV/AIDS program-funded clinics across Alabama that serve diverse and rural populations. Graduate-level providers (supervised by a licensed clinical psychologist) will provide the interventions (BI and CETA) remotely using telemedicine approaches that were rapidly expanded during the COVID-19 pandemic. Both research projects will also evaluate implementation factors, to enhance the impact of clinical effectiveness data, and both projects will be supported by 3 resource cores: a CETA core for clinical intervention training and oversight, a Methods and Analysis core to harmonize data elements across projects and create synergy in data analyses, and an Administrative core to manage business and regulatory requirements of the P01, monitor and manage overall progress, and promote bidirectional knowledge and idea exchange between Southern U.S.- and sub-Saharan Africa-focused investigators.

项目概要/摘要 赞比亚阿拉巴马州艾滋病毒酒精合并症计划 (ZAMBAMA) 的总体目标是（目标 1）测试 跨诊断模型、通用要素治疗方法 (CETA) 的有效性，以减少 不健康饮酒并改善资源不足的艾滋病毒诊所的艾滋病毒临床结果，（目标 2）评估 CETA 影响 HIV 结果的机制，（目标 3）调查治疗效果是否 CETA 因临床（例如，是否存在合并症）、人口统计（例如，性别）和/或背景因素而异 （例如赞比亚、阿拉巴马州）和（目标 4）审查与综合相关的实施因素，包括成本 向感染艾滋病毒和不健康饮酒的弱势群体提供减少饮酒干预措施 P01 的中心主题是，在艾滋病毒感染者和不健康饮酒者中，整合 筛查和治疗常见的行为和心理健康合并症将减少不健康的饮酒 ZAMBAMA 将由一个合作团队实施，该团队带来了 由资深研究人员和年轻研究人员组成的小组共同努力解决艾滋病毒关系方面的科学空白， 全球艾滋病毒应对措施中优先地理区域的物质使用和精神疾病：撒哈拉以南非洲 和美国南部，该团队将共同在成人中实施两项随机对照临床试验 HIV 和不健康的酒精使用，以评估 CETA 对酒精使用的影响，HIV 护理连续体（抗逆转录病毒药物） 治疗、艾滋病毒护理的依从性和保留、病毒抑制）以及常见的心理健康和 物质使用合并症项目 1（赞比亚 CETA 艾滋病毒酒精减少试验 - CHARTZ）将 在赞比亚的公共部门初级艾滋病毒诊所实施，那里现有艾滋病毒“同伴教育者”（即非专业人士） 辅导员）将接受培训，为参与者提供酒精简短干预（BI）和CETA 项目 2（使用 CETA - TALC 对艾滋病毒感染者进行不健康饮酒的远程医疗） 将在 Ryan White 社区招募艾滋病毒护理参与者，该社区接受艾滋病毒/艾滋病项目资助的诊所 阿拉巴马州为多元化和农村人口提供服务的研究生级别的提供者（由有执照的临床人员监督）。 心理学家）将使用远程医疗方法远程提供干预措施（BI 和 CETA） 在 COVID-19 大流行期间迅速扩大，这两个研究项目也将实施实施评估。 因素，增强临床有效性数据的影响力，两个项目都将得到3个资源的支持 核心：用于临床干预培训和监督的 CETA 核心，用于协调的方法和分析核心 跨项目的数据元素并在数据分析中创建协同作用，以及管理核心 P01的业务和监管要求，监控和管理整体进度，并促进 以美国南部和撒哈拉以南非洲地区为重点的双向知识和思想交流 调查人员。