Effectiveness of Alcohol Interventions Among TB Patients in Tomsk, Russia

俄罗斯托木斯克结核病患者酒精干预的有效性

基本信息

批准号：
7493124
负责人：
SONYA S SHIN
金额：
$ 34.36万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-30 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7493124
关键词：
Address Adherence Affect Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Alcohols Behavior Therapy Behavioral Biosocial Caring Case Management Cause of Death Chronic Clinic Clinical Trials Communities Condition Counseling Dependence Directly Observed Therapy Disease Disease Management Effectiveness Effectiveness of Interventions Ensure Evaluation Evidence based practice Feasibility Studies Goals Guidelines HIV Infections Health Health Services Health Services Research Incentives Individual International Intervention Knowledge Link Medical Modeling Monitor Morbidity - disease rate Motivation Multidrug-Resistant Tuberculosis NIH Program Announcements Naltrexone National Institute on Alcohol Abuse and Alcoholism Outcome Patient Care Patients Persons Pharmaceutical Preparations Pharmacotherapy Phase Physicians Play Population Prevention Process Protocols documentation Public Health Randomized Randomized Clinical Trials Rate Research Research Personnel Risk Role Route Russia Services Specialist Specific qualifier value Standards of Weights and Measures System Toxic effect Translating Treatment outcome Tuberculosis United States Upper arm World Health Organization addiction alcohol abuse therapy alcohol intervention alcohol use disorder antiretroviral therapy base care delivery care systems chemotherapy design drinking behavior experience health care model innovation interdisciplinary collaboration mortality neglect pressure programs socioeconomics treatment program trial comparing tuberculosis treatment

项目摘要

DESCRIPTION (provided by applicant): Two major public health issues in Russia are alcohol use disorders (AUDs) and tuberculosis (TB). AUDs play a synergistic role in the morbidity and mortality associated with TB. Despite the implementation of DOTS (Directly Observed Therapy - Short Course Chemotherapy) endorsed by the World Health Organization, many TB programs in Russia have been unsuccessful, in large part due to the overwhelming impact of AUDs on nonadherence and, ultimately, poor treatment outcomes. Yet, management of concurrent AUDs among TB patients in Russia has been neglected. Therefore, we aim to examine the effectiveness of two proven alcohol interventions when integrated as part of routine TB care among patients with co-occurring TB and AUDs in Tomsk, Russia. An important aspect of the delivery of these alcohol interventions will be their incorporation into DOTS TB care services, utilizing the strengths of directly observed therapy, case holding strategies, and frequent routing monitoring. We propose a Phase III clinical trial comparing alcohol and TB treatment outcomes among individuals with TB and alcohol abuse/dependence who are randomized to one of the following interventions: 1. Behavioral Counseling Intervention (BCI) delivered by TB physicians at monthly patient evaluations plus treatment as usual (TAU); 2. Naltrexone administered under directly observed therapy plus TAU; 3. BCI, naltrexone and TAU; or 4. TAU. If proven effective, such innovations in health service delivery of alcohol interventions within the TB health care model could have a major public health impact in Russia. Our research team has extensive experience in research on alcohol and other substance-dependent patients. We also have a firmly established programmatic and research presence in Tomsk, with unique relations with out Tomsk colleagues that will ensure the feasibility of this study. Finally, we have a diverse interdisciplinary team that has been able to formulate an integrated biosocial and culturally-appropriate approach to treating AUDs in this population.

描述（由申请人提供）：俄罗斯的两个主要公共卫生问题是酒精使用障碍（AUD）和结核病（TB）。 AUD 在与结核病相关的发病率和死亡率中发挥协同作用。尽管实施了世界卫生组织认可的 DOTS（直接观察治疗 - 短期化疗），但俄罗斯的许多结核病项目并未取得成功，这在很大程度上是由于 AUD 对不依从性的巨大影响，并最终导致治疗结果不佳。然而，俄罗斯结核病患者并发 AUD 的管理却被忽视。因此，我们的目的是检查两种经过验证的酒精干预措施作为常规结核病护理的一部分对俄罗斯托木斯克同时发生结核病和 AUD 的患者的有效性。提供这些酒精干预措施的一个重要方面是将其纳入 DOTS 结核病护理服务，利用直接观察治疗、病例保留策略和频繁路线监测的优势。我们建议开展一项 III 期临床试验，比较患有结核病和酒精滥用/依赖的个体的酒精和结核病治疗结果，这些患者被随机接受以下干预措施之一： 1. 结核病医生在每月的患者评估和治疗中提供行为咨询干预 (BCI)像往常一样（TAU）； 2.在直接观察治疗加TAU的情况下给予纳曲酮； 3.BCI、纳曲酮和TAU；或 4. TAU。如果证明有效，结核病卫生保健模式中酒精干预卫生服务提供的此类创新可能会对俄罗斯的公共卫生产生重大影响。我们的研究团队拥有丰富的经验对酒精和其他物质依赖患者的研究。我们还拥有牢固的托木斯克的计划和研究存在，与托木斯克同事的独特关系将确保这项研究的可行性。最后，我们拥有一支多元化的跨学科团队，能够制定一种综合的生物社会和文化适当的方法来治疗该人群的 AUD。