Integration of Evidence-based Alcohol Interventions into HIV Care

将循证酒精干预措施纳入艾滋病毒护理

基本信息

批准号：
8330815
负责人：
Michael S. Saag
金额：
$ 48.16万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-10 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8330815
关键词：
Accident and Emergency department Address Adherence Adoption Alcohol abuse Alcohol consumption Alcohols Caring Case Management Clinic Clinical Clinical Trials Communities Computers Disease Progression Effectiveness FDA approved Funding HIV Health Individual Intervention Knowledge Life Long-Term Care Longevity Mainstreaming Maintenance Medical Mental Depression Meta-Analysis Modeling Morbidity - disease rate Online Systems Outcome Participant Patient Care Patients Persons Pharmaceutical Preparations Pharmacotherapy Play Primary Health Care Principal Investigator Provider Quality of life Randomized Reporting Research Role Screening procedure Services Site Stream System Training Translations Treatment Efficacy Visit alcohol abuse therapy alcohol intervention alcohol screening and brief intervention alcohol services alcohol use disorder alcoholism pharmacotherapy alcoholism therapy antiretroviral therapy binge drinking brief alcohol intervention brief intervention clinical care clinical practice cohort comparative effectiveness compare effectiveness computerized cost cost effectiveness drinking effectiveness trial evidence base follow-up hazardous drinking improved interest medical specialties mortality outreach point of care reduced alcohol use response standard care standard of care university student uptake

项目摘要

DESCRIPTION (provided by applicant): Hazardous alcohol use is prevalent among HIV infected individuals, and is associated with decreased antiretroviral therapy uptake, adherence, and virologic suppression. Unfortunately, patient engagement and retention in traditional alcohol treatment services is poor. Screening, brief alcohol intervention, and referral to treatment (SBIRT) has been shown to be effective in reducing hazardous alcohol use and improving health- related outcomes in primary care and emergency room settings. In addition to SBIRT, there are several FDA-approved pharmacotherapies with demonstrated efficacy in reducing alcohol consumption. Providing intervention at the point-of-care through SBIRT in HIV clinics offers an excellent opportunity for integration of brief alcohol intervention and alcohol pharmacotherapy. Utilizing the CFAR Network of Integrated Clinical Systems (CNICS), a national network comprised of 8 clinical cohorts and over 20,000 HIV-infected individuals across the US, we will examine the effectiveness of a computer-delivered brief intervention as well as a an HIV provider pharmacotherapy training to prescribe alcohol treatment medications delivered in the HIV clinical care setting. All CNICS patients will be screened for hazardous or binge drinking and individuals with positive screens will be administered the computerized brief intervention (CBI) at their first visit. At the second visit (approximately 3 months later), participants who continue to screen positive will receive either another session of CBI or will be offered CBI and alcohol pharmacotheray (CBl+APT). All participants will be followed for an additional 6 months to determine alcohol reduction and HIV-related outcomes. It is expected that CBl+APT will be more effective than CBI alone, while CBI alone will be more effective than standard of care for reducing hazardous drinking and improving HIV-related outcomes. Further, we will examine patient-related predictors of engagement and retention in care and determine barriers to successful integration of these interventions in the HIV clinical care setting. Finally, cost- effectiveness analyses will be conducted to determine the impact of these interventions in this setting.

描述（由申请人提供）：有害饮酒在 HIV 感染者中很普遍，并且与抗逆转录病毒治疗的吸收、依从性和病毒学抑制的减少有关。不幸的是，患者对传统酒精治疗服务的参与度和保留率都很差。筛查、简短的酒精干预和转诊治疗 (SBIRT) 已被证明可以有效减少危险酒精的使用并改善初级保健和急诊室环境中与健康相关的结果。除了 SBIRT 之外，还有几种经 FDA 批准的药物疗法已被证明可以有效减少饮酒。通过 HIV 诊所的 SBIRT 在护理点提供干预为短期酒精干预和酒精药物治疗的整合提供了绝佳的机会。利用 CFAR 综合临床系统网络 (CNICS)（一个由全美 8 个临床队列和 20,000 多名 HIV 感染者组成的全国网络），我们将检查计算机提供的简短干预措施以及 HIV 提供者的有效性在艾滋病毒临床护理机构中提供药物治疗培训，以开出酒精治疗药物。所有 CNICS 患者都将接受危险饮酒或酗酒筛查，筛查结果呈阳性的个体将在首次就诊时接受计算机化简短干预 (CBI)。在第二次访视时（大约 3 个月后），继续筛查呈阳性的参与者将接受另一次 CBI 治疗，或者将接受 CBI 和酒精药物治疗 (CBl+APT)。所有参与者将被额外跟踪 6 个月，以确定饮酒减少和艾滋病毒相关的结果。预计 CBl+APT 将比单独 CBI 更有效，而单独 CBI 将比标准护理更有效地减少有害饮酒和改善 HIV 相关结果。此外，我们将检查与患者相关的参与和保留护理的预测因素，并确定将这些干预措施成功整合到艾滋病毒临床护理环境中的障碍。最后，将进行成本效益分析，以确定这些干预措施在此环境中的影响。