Behavioral interventions to reduce heavy drinking in HIV-infected men in primary care.

减少初级保健中艾滋病毒感染男性酗酒的行为干预措施。

• 批准号: 8838920
• 负责人: Christopher W. Kahler
• 金额: $ 43.32万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838920
• 关键词: Address; Alcohol consumption; Alcohol dependence; Alcohols; Anus; Behavior Therapy; Behavioral; CD4 Lymphocyte Count; Caring; Cellular Phone; Clinic; Collaborations; Counseling; Data; Disease; Effectiveness; Feedback; Functional disorder; HIV; HIV Infections; Heavy Drinking; Infection; Inflammation; Insulin Resistance; Intervention; Lead; Life; Liver Function Tests; Liver diseases; Location; Metabolic; Monitor; Motivation; Neurocognitive; Outcome; Oxidative Stress; Participant; Patients; Phase; Population; Primary Health Care; Publishing; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recruitment Activity; Relative (related person); Research; Risk; Sampling; Serum; System; Technology; Telemedicine; Testing; Text; Time; Viral; Voice; Work; alcohol intervention; alcohol use disorder; antiretroviral therapy; base; biobehavior; brief advice; brief motivational intervention; clinical care; cognitive function; cost; cost effectiveness; design; drinking; follow-up; hazardous drinking; improved; indexing; individualized medicine; liver function; men; men who have sex with men; problem drinker; public health priorities; response; secondary outcome; sex; sex risk; sexual risk taking; therapy adherence; treatment as usual; virology

PROJECT SUMMARY Heavy drinking in HIV-infected patients can lead to low antiretroviral therapy adherence and poor virologic control, greater sexual risk taking, increased risk of liver disease, and decreased cognitive function. Therefore, reductions in drinking may have particularly positive and widespread effects in HIV-infected patients. Men who have sex with men (MSM) continue to represent the majority of new HIV infections, and HIV-infected MSM have rates of hazardous drinking as high as 33%. Therefore, developing and testing interventions to reduce heavy drinking in HIV-infected MSM is a very high public health priority. There have been relatively few alcohol interventions tested that focus on MSM, and only two have addressed drinking in HIV-infected MSM. Although recent studies indicate that behavioral interventions can reduce heavy drinking in HIV-infected patients, much remains unknown about the efficacy of different approaches to behavioral intervention and their unique and combined effects. The purpose of the present study is to conduct a fully-crossed 2 X 2 X 2 factorial randomized controlled trial with a diverse sample of 224 MSM recruited from 2 urban HIV primary care clinics (one in the Northeast and one in the South). The first study factor will compare brief advice (BA) vs. a motivation intervention (MI) that contains detailed personalized normative and HIV-specific feedback. The second factor compares an interactive text messaging (ITM) intervention vs. no text messaging. The final factor compares intervention of low intensity and duration (two sessions over 1 month) to extended intervention (EI) entailing 5 sessions over 9 months. BA and MI will be delivered by a core set of interventionists from a central location using a webcam-enabled telemedicine system, which can facilitate larger-scale implementation. The design will allow us to test the hypothesis that MI compared to BA, ITM compared to no ITM, and EI compared to no EI, will result in significantly greater reductions in number of alcoholic drinks consumed and number of heavy drinking days at 6- and 12-month follow-ups. Secondary outcomes include engagement in unprotected anal intercourse, ART adherence and viral suppression, CD4 cell count, liver function tests, and neurocognitive function. We also will test the hypothesis that the effects of MI, ITM, and EI on drinking will be moderated by alcohol use disorder status and readiness to change drinking such that these interventions will be relatively more efficacious in those with a current disorder and those with low readiness. The study will provide crucial evidence regarding which intervention approaches, alone or in combination, are likely to be most efficient to implement on a large scale in HIV care settings.

项目概要 HIV感染者大量饮酒可能导致抗逆转录病毒治疗依从性低和病毒学不良 控制、更大的性冒险、肝病风险增加以及认知功能下降。所以， 减少饮酒可能对艾滋病毒感染者产生特别积极和广泛的影响。男人谁 男男性行为 (MSM) 仍然占新发艾滋病毒感染者的大多数，并且感染艾滋病毒的男男性行为者 危险饮酒率高达33%。因此，开发和测试干预措施以减少 感染艾滋病毒的男男性行为者的大量饮酒是一个非常重要的公共卫生优先事项。酒精含量相对较少 测试的干预措施主要针对男男性行为者，只有两项针对感染艾滋病毒的男男性行为者的饮酒问题。虽然 最近的研究表明，行为干预可以减少艾滋病毒感染者的酗酒， 不同行为干预方法的功效及其独特和有效的方法仍然未知 综合效应。本研究的目的是进行完全交叉的 2 X 2 X 2 阶乘随机 一项对照试验，从 2 个城市 HIV 初级保健诊所（其中一个位于 东北各一个，南方各一个）。第一个研究因素将比较简短建议 (BA) 与动机 干预 (MI)，其中包含详细的个性化规范和针对 HIV 的反馈。第二个因素 比较了交互式短信 (ITM) 干预与无短信干预。最终因素比较 低强度和持续时间的干预（1 个月内两次疗程）到需要 5 次的长期干预 (EI) 会议持续超过 9 个月。 BA 和 MI 将由一组核心干预专家从中心位置提供 使用支持网络摄像头的远程医疗系统，这可以促进更大规模的实施。设计 将使我们能够检验以下假设：MI 与 BA 相比、ITM 与无 ITM 相比、EI 与无 ITM 相比 EI，将导致饮酒量和重度酒精饮料的数量显着减少 6 个月和 12 个月随访时的饮酒天数。次要结果包括进行无保护的肛交 性交、ART 依从性和病毒抑制、CD4 细胞计数、肝功能测试和神经认知 功能。我们还将检验以下假设：MI、ITM 和 EI 对饮酒的影响将受到以下因素的调节： 酒精使用障碍状况和改变饮酒的准备程度，以便这些干预措施相对有效 对于目前患有疾病和准备程度较低的人来说更有效。该研究将提供至关重要的 有关哪些干预方法（单独或组合）可能最有效的证据 在艾滋病毒护理机构中大规模实施。