Primary Care-Based Interventions to Reduce Alcohol Use Among HIV Patients

以初级保健为基础的干预措施，以减少艾滋病毒患者的饮酒

• 批准号: 8718954
• 负责人: Derek D Satre
• 金额: $ 59.77万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-10 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8718954
• 关键词: AIDS/HIV problem; Adherence; Adoption; Adverse effects; Aging; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anti-Retroviral Agents; Behavior Therapy; Biometry; California; Caring; Clinic; Clinical; Clinical Psychology; Cohort Studies; Computerized Medical Record; Data; Drug abuse; Emerging Technologies; Enrollment; Environment; Epidemiology; Feedback; HIV; HIV Infections; Health Planning; Health behavior change; Healthcare; Individual; Integrated Delivery of Health Care; Intervention; Interview; Laboratories; Life; Measures; Mental Depression; Mental Health; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Population Study; Primary Health Care; Qualifying; RNA; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Risk; San Francisco; Scientist; Secure; Severities; Stratification; System; Telephone; Testing; Unsafe Sex; Veterans; Woman; alcohol abuse therapy; alcohol related problem; alcohol screening; antiretroviral therapy; arm; base; behavioral health; comparative effectiveness; computerized; cost; cost effective; cost effectiveness; design; drinking; follow-up; hazardous drinking; health care service utilization; high risk sexual behavior; improved; indexing; innovation; intervention effect; men; mortality; motivational enhancement therapy; novel; prognostic; randomized trial; reduced alcohol use; response; screening; therapy adherence; tool; transmission process; treatment as usual; treatment program

DESCRIPTION (provided by applicant): This application responds to RFA-AA-12-009, Interventions to Improve HIV/AIDS and Alcohol-Related Outcomes (U01). The proposed study takes place in a HIV primary care clinic and uses the health plan's electronic medical record (EMR) for screening; it has the potential to provide a significant benefit to HIV- infected individuals by reducing hazardous drinking and the associated complications. Prior studies have identified high rates of co-occurrence of HIV and hazardous drinking (defined as drinking over threshold limits, i.e., 5+ daily or 14+ weekly drinks for men and 4+ daily or 7+ weekly drinks for women). Drinking at these levels can compromise antiretroviral (ART) treatment and increase rates of depression, unsafe sex, and mortality. The proposed randomized trial examines the comparative effectiveness of two highly implementable behavioral interventions for reducing hazardous drinking, each with an adaptive, stepped-care component: 1) Motivational Interviewing (MI), consisting of one in-person session with a study clinician and two phone sessions, with three additional phone sessions for those who report hazardous drinking at 6 months; and 2) interactive Emailed Feedback (EF) on hazardous drinking risks using a secure messaging system integrated into the Electronic Medical Record (EMR), with additional emailed feedback for those who report hazardous drinking at 6 months. A third arm will be usual care. We will also evaluate the cost-effectiveness of the two interventions which have the potential for wide adoption in other similar healthcare settings. The two proposed interventions, MI and EF, are promising approaches for reducing hazardous drinking in the setting of behavioral health and/or primary care. EF also uses secure messaging, an emerging technology that has been tested in other health, behavior change and mental health treatment settings, for problems including alcohol use but not among HIV-infected individuals. In this trial, 600 patients (200 in each arm) will be recruited from Kaiser Permanente Northern California (KPNC) San Francisco. The study population and clinic are ideal to examine such interventions since NIAAA-based screening questions are recorded in the EMR, and comprehensive data are available on health care utilization, ART adherence, and HIV clinical outcomes, including the Veterans Aging Cohort Study (VACS) index, a recently validated prognostic index based on routine clinical laboratory measures. The research team is well-qualified with complementary expertise in clinical psychology, drug and alcohol abuse treatment, HIV epidemiology, and biostatistics. Thus, the team and study setting provide the ideal environment to test MI and EF, two innovative approaches for reducing hazardous alcohol use in this population, and may provide powerful, generalizable tools for assisting individuals with HIV infection.

描述（由申请人提供）：此申请对RFA-AA-12-009做出响应，改善艾滋病毒/艾滋病和酒精相关结果的干预措施（U01）。拟议的研究发生在HIV初级保健诊所，并使用健康计划的电子病历（EMR）进行筛查。它有可能通过减少危险饮酒和相关并发症来为受艾滋病毒感染的个体带来重大好处。先前的研究已经确定了艾滋病毒和危险饮酒的同时流动率很高（定义为饮酒超过阈值限制，即每天5次以上或每周14次以上的男性饮料和每天4次以上的饮料或每周4次以上的女性饮料）。在这些水平上喝酒会损害抗逆转录病毒（ART）治疗，并增加抑郁症，不安全性别和死亡率的率。拟议的随机试验检查了两种高度可实施的行为干预措施以减少危险饮酒的比较有效性，每种饮酒都有一个自适应，阶梯式护理的组成部分：1）动机访谈（MI）（MI），包括一个与研究临床医生和两个手机课程组成，并为两次手机疗程，并为那些在6个月饮酒时进行三个额外的电话会议，并为3个月报告的人提供三个额外的电话。 2）使用集成到电子病历（EMR）中的安全消息系统（EMR）的危险饮酒风险的交互式电子邮件反馈（EF），并为那些在6个月时报告有害饮酒的人提供了其他电子邮件反馈。第三臂将是通常的护理。我们还将评估两种干预措施的成本效益，这些干预措施有可能在其他类似的医疗机构中广泛采用。提出的两种干预措施MI和EF是在行为健康和/或初级保健的情况下减少危险饮酒的有前途的方法。 EF还使用安全消息传递，这是一种在其他健康，行为改变和心理健康治疗环境中进行了测试的新兴技术，用于包括饮酒在内的问题，但在感染HIV感染的人中却没有。在这项试验中，将从北加州的Kaiser Permanente（KPNC）旧金山招募600名患者（每只手臂为200名）。由于在EMR中记录了基于NIAAA的筛查问题，因此研究人群和诊所是检查此类干预措施的理想选择，并且可以在医疗保健利用，艺术依从性和HIV临床结果上获得全面的数据，包括退伍军人衰老队列研究（VACS）索引，最近验证的预后指数基于常规的预后指数。研究小组在临床心理学，药物和酗酒治疗，艾滋病毒流行病学和生物统计学方面具有互补的专业知识，因此具有良好的资格。因此，团队和研究环境为测试MI和EF提供了理想的环境，这是减少该人群中危险饮酒的两种创新方法，并可能提供强大的，可推广的工具，以帮助艾滋病毒感染的人。