Mobile technology to extend clinic-based counseling for HIV+s in Uganda

移动技术在乌干达扩大艾滋病毒临床咨询

• 批准号: 9906836
• 负责人: JUDITH ALISSA HAHN
• 金额: $ 31.28万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906836
• 关键词: Adherence; Africa South of the Sahara; Alcohol consumption; Alcohols; Anti-Retroviral Agents; Biological Markers; Blood; Car Phone; Caring; Cellular Phone; Clinic; Clinic Visits; Communities; Consumption; Counseling; Data; Development; Effectiveness; Failure; Fees; Focus Groups; Frequencies; Future; Gender; Goals; HIV; Health; Heavy Drinking; Hour; Human Resources; Individual; Intervention; Intervention Studies; Interview; Maintenance; Measures; Methods; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Persons; Population Heterogeneity; Prevalence; Professional counselor; Provider; Randomized Controlled Trials; Research; Resources; Rural; Schedule; Spottings; Surveys; System; Technology; Telephone; Testing; Text; Text Messaging; Time; Uganda; Viral; Visit; Voice; Waiting Lists; Work; alcohol intervention; alcohol misuse; arm; base; brief alcohol intervention; cost; cost estimate; design; drinking; experience; improved; intervention cost; member; mobile computing; mortality; phosphatidylethanol; post intervention; reduced alcohol use; response; satisfaction; screening; standard of care; successful intervention; tailored messaging; theories; three-arm study; uptake

Abstract Alcohol consumption is a critical predictor of poor HIV outcomes such as reduced antiretroviral adherence and lack of viral suppression. Reducing unhealthy alcohol use among those with HIV may improve HIV outcomes and thus is a high priority. HIV prevalence and unhealthy drinking rates are high in sub-Saharan Africa (SSA). Multi-session approaches to screening and brief counseling have good evidence for reducing alcohol use in resource rich settings and in persons with HIV. However, multiple in-person sessions are costly and unlikely to be scalable in SSA. Thus, there is a need to develop and test low-cost alternatives. A successful multi-contact alcohol intervention studied in the US uses phone-based booster sessions with a live counselor (“live boosters”) to reinforce the content of two brief in-person sessions. Because cell phone coverage is widespread in SSA, an intervention that uses live boosters may be feasible, particularly if the in-person sessions coincide with regular clinic visits. However, live booster calls can be labor intensive and dependent on a good phone network. Alternatively, automated booster sessions can be conducted via cell phone using short message service (SMS, i.e. text) or interactive voice response (IVR) systems, to provide brief 2-way interactive sessions (“tech boosters”). These systems are likely to be at low cost and burden to providers and patients. The SMS/IVR systems allow for tailoring the 2-way booster sessions on variables such as gender and drinking goals. The primary aims of this developmental study are (1) To adapt a successful alcohol intervention for unhealthy drinkers with HIV in Uganda to include in-person sessions that coincide with two routine quarterly clinic visits, with live booster calls delivered between in-person sessions, and to develop tech boosters as a scalable alternative to live calls. We will collect qualitative data via focus group discussions and individual in- depth interviews to elicit community and patient input into the content and delivery of the interventions. (2) To conduct a pilot randomized controlled trial (RCT) to test these methods for unhealthy drinkers in HIV care in rural Uganda (n=270). The study arms will be: (a) in-person counseling during 2 quarterly clinic visits plus live booster calls every 3 weeks in the interim, (b) in-person counseling during 2 quarterly clinic visits plus twice weekly tech (choice of SMS or IVR) boosters in the interim, and (c) standard of care control (brief unstructured advice, with a wait-listed intervention). We will obtain preliminary estimates of uptake, acceptability, cost, and efficacy in reducing alcohol use and decreasing viral failure for each study arm at six months. We will utilize an alcohol biomarker, phosphatidylethanol, in addition to self-reported alcohol use, and measure viral suppression via dried blood spots. This study will be conducted in a large rural Ugandan HIV clinic where we have 10 years of collaborating on alcohol/HIV research. The study will adapt a successful intervention and develop low-cost delivery methods, and the pilot RCT results will inform the design of a larger trial of a low-cost intervention to reduce alcohol use and increase viral suppression among those with HIV in SSA.

抽象的 饮酒是艾滋病毒不良结果的一个重要预测因素，例如抗逆转录病毒药物依从性降低和 缺乏病毒抑制。减少艾滋病毒感染者不健康的饮酒可能会改善艾滋病毒的结果。 因此，撒哈拉以南非洲地区 (SSA) 的艾滋病毒感染率和不健康饮酒率很高。 多次筛查和简短咨询的方法对于减少酒精使用有充分的证据。 然而，多次面对面的会议成本高昂且不太可能实现。 因此，需要开发和测试成功的多触点替代方案。 美国研究的酒精干预方法是通过电话与现场辅导员进行加强课程（“现场辅导”）。 助推器”）来强化两次简短的现场会议的内容，因为手机覆盖范围很广。 在 SSA 中，使用现场助推器的干预措施可能是可行的，特别是当面对面会议同时进行时 然而，现场助推器呼叫可能会耗费大量人力，并且依赖于良好的电话。 或者，可以通过手机使用短信进行自动加强会议。 服务（SMS，即文本）或交互式语音应答 (IVR) 系统，提供简短的双向交互式会话 （“技术助推器”）这些系统的成本可能较低，对提供者和患者的负担也较小。 SMS/IVR 系统允许根据性别和饮酒等变量定制双向强化课程 这项发展研究的主要目标是 (1) 成功地进行酒精干预。 乌干达感染艾滋病毒的不健康饮酒者将在两个例行季度会议期间举行面对面会议 诊所访问，在面对面会议之间进行现场助推器电话，并开发技术助推器作为 我们将通过焦点小组讨论和个人反馈来收集定性数据。 (2) 至 进行一项试点随机对照试验（RCT），以测试这些方法在艾滋病毒护理中对不健康饮酒者的影响 乌干达农村地区（n=270）。研究部门将：（a）每季度两次的现场咨询以及现场咨询。 在此期间每 3 周进行一次辅助电话，(b) 在 2 次季度诊所就诊期间进行现场咨询，另加两次 在此期间每周提供技术支持（选择 SMS 或 IVR），以及 (c) 护理控制标准（简短的非结构化 建议，并进行等待名单干预）。 我们将在六个月时对每个研究组使用减少酒精使用和减少病毒失败的功效。 除了自我报告的饮酒情况外，还检测酒精生物标志物磷脂酰乙醇，并测量病毒抑制 这项研究将在乌干达一个大型农村艾滋病毒诊所进行，我们已经在那里工作了 10 年。 该研究将采用成功的干预措施并开发低成本。 交付方法，并且试点随机对照试验结果将为设计更大规模的低成本干预试验提供信息 减少 SSA 艾滋病毒感染者的饮酒并增强病毒抑制。