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: 8542746
• 负责人: Derek D Satre
• 金额: $ 59.65万
• 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/8542746
• 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）：本申请响应 RFA-AA-12-009，改善艾滋病毒/艾滋病和酒精相关结果的干预措施 (U01)。拟议的研究在艾滋病毒初级保健诊所进行，并使用健康计划的电子病历（EMR）进行筛查；通过减少有害饮酒和相关并发症，它有可能为艾滋病毒感染者带来重大益处。先前的研究已发现艾滋病毒和危险饮酒（定义为饮酒超过阈值，即男性每天饮酒 5 次以上或每周饮酒 14 次以上，女性每日饮酒 4 次以上或每周饮酒 7 次以上）的同时发生率很高。饮酒过量会影响抗逆转录病毒 (ART) 治疗，并增加抑郁症、不安全性行为和死亡率。拟议的随机试验检验了两种高度可实施的行为干预措施在减少危险饮酒方面的比较有效性，每种干预措施都具有适应性、阶梯式护理成分：1）动机访谈（MI），包括与研究临床医生的一次面对面会议和两次与研究临床医生的面对面会议。电话会议，为 6 个月大时报告危险饮酒的儿童提供额外 3 次电话会议； 2) 使用集成到电子病历 (EMR) 中的安全消息系统对危险饮酒风险进行交互式电子邮件反馈 (EF)，并为 6 个月内报告危险饮酒的人员提供额外的电子邮件反馈。第三只手臂将进行常规护理。我们还将评估这两种干预措施的成本效益，这两种干预措施有可能在其他类似的医疗保健环境中广泛采用。 MI 和 EF 这两种拟议的干预措施是在行为健康和/或初级保健环境中减少危险饮酒的有希望的方法。 EF 还使用安全消息传递，这是一种新兴技术，已在其他健康、行为改变和心理健康治疗环境中进行了测试，可解决包括饮酒在内的问题，但不适用于艾滋病毒感染者。在这项试验中，将从旧金山北加州凯撒医疗机构 (KPNC) 招募 600 名患者（每组 200 名）。研究人群和诊所是检查此类干预措施的理想选择，因为 EMR 中记录了基于 NIAAA 的筛查问题，并且可以获得有关医疗保健利用、ART 依从性和 HIV 临床结果的全面数据，包括退伍军人老龄化队列研究 (VACS)指数，最近基于常规临床实验室测量验证的预后指数。该研究团队资质良好，在临床心理学、药物和酒精滥用治疗、艾滋病毒流行病学和生物统计学方面拥有互补的专业知识。因此，该团队和研究环境为测试 MI 和 EF（这两种减少该人群危险酒精使用的创新方法）提供了理想的环境，并可能为帮助 HIV 感染者提供强大的、通用的工具。