Technology-based assessments and intervention to reduce alcohol consumption and improve HIV viral suppression in the Florida Cohort

基于技术的评估和干预，以减少佛罗里达队列的饮酒量并改善艾滋病病毒抑制

• 批准号: 10707386
• 负责人: Robert L Cook
• 金额: $ 62.58万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707386
• 关键词: Address; Adherence; Age; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Anxiety; Applications Grants; Appointment; Area; Area Under Curve; Biosensor; Blood; Caring; Cellular Phone; Clinic; Clinical; Collaborations; Communities; Data; Development; Dryness; Ecological momentary assessment; Economics; Enrollment; Ethnic Origin; Florida; Foundations; Gender; Goals; HIV; Health; Health system; Healthcare Systems; Individual; Intervention; Life; Measures; Mental Depression; Mental Health; Mission; Modeling; Monitor; Outcome; Pain; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Population Heterogeneity; Postdoctoral Fellow; Provider; Race; Regimen; Reporting; Research; Research Personnel; Research Support; Risk Factors; Secure; Solid; Spottings; Stress; Surveys; Technology; Testing; Therapeutic; Time; Training; Universities; Viral; Viral Load result; Virginia; Wrist; absorption; alcohol intervention; assessment application; barrier to care; cohort; community setting; community-level factor; design; drinking; effectiveness/implementation trial; ethnic minority; improved; mHealth; mobile computing; multimodality; next generation; peer support; pre-doctoral; programs; rural area; social; success; support network; surveillance data; syndemic; tool; treatment as prevention

SUMMARY The majority of persons with HIV (PWH) in the US consume alcohol, despite that alcohol use is associated with lower levels of HIV care engagement and HIV viral suppression. Over the past decade, our research team has established the Florida Cohort to support research and training with a mission to maximize HIV viral suppression and improve health outcomes in PWH. Key features of the Florida Cohort include a focus on alcohol-related issues, academic and community-based partnerships across the state, targeted enrollment of diverse populations, and linkage to statewide HIV surveillance data. Meanwhile, several agencies in Florida are implementing new interventions to help achieve HIV viral suppression, including the PositiveLinks (PL) app. The overarching goals of the current grant proposal are to advance understanding of the mechanisms influencing adherence to contemporary HIV therapeutic regimens, and to incorporate alcohol-related interventions into emerging strategies to achieve and maintain HIV viral suppression across diverse populations. We propose to enroll and survey 1200 new Florida Cohort participants, with targeted enrollment for heavy drinkers and sexual/ethnic minorities. The survey data will allow us to identify multilevel factors contributing to ART adherence and viral suppression among alcohol-using PWH. From the overall cohort, 80 alcohol-using PWH will complete “enhanced monitoring (EM)” for one month. The EM group will wear a wrist alcohol biosensor, report alcohol and other risk factors (e.g., real-time anxiety, depression) and ART adherence through an ecological momentary assessment (EMA) app, and provide two dried blood spots (DBS) viral load tests. The EM data will help disentangle the temporal relationships between alcohol, other risk factors, and ART adherence in real-time. Survey and EM data together with input from the EM participants will be used to inform the development of several aspects of the biosensor-based intervention. Our interdisciplinary team will also meet regularly with a new Community/Provider Advisory Board (CAB), who will provide input related to the ongoing Florida Cohort (e.g., enrollment, survey design) and help develop a plan to integrate the alcohol biosensor-based intervention into the PL app. The specific aims include: 1) Systematically investigate multilevel factors based on the social-ecological model and WHO model that influence ART adherence and subsequently HIV viral suppression in alcohol-using vs. non-using PWH. 2) In 80 alcohol-using PWH, use alcohol biosensors and EMA data to identify alcohol consumption patterns and risk factors most strongly associated with ART non-adherence and poor HIV viral suppression. 3) Develop an intervention that incorporates an alcohol biosensor into an existing mHealth ART adherence intervention, with input from alcohol-using PWH and a Community/Provider Advisory Board. The rich information we collect in this project will establish a solid foundation for our next step: a hybrid implementation/effectiveness trial of an integrated alcohol intervention across a large network of clinic-/community-based HIV settings in Florida.

概括 美国大多数艾滋病毒（PWH）的大多数人都用酒精饮酒，酒精使用与 较低的艾滋病毒护理参与和艾滋病毒抑制。在过去的十年中，我们的研究团队有 建立了佛罗里达人队列，以支持研究和培训，以最大化艾滋病毒病毒 抑制和改善PWH的健康结果。佛罗里达队列的主要特征包括关注 全州与酒精有关的问题，学术和社区的合作伙伴关系，针对 多样化的人群，并与全州艾滋病毒监测数据联系在一起。同时，佛罗里达州的几个机构 正在实施新的干预措施，以帮助实现HIV病毒抑制，包括Patorivelinks（PL） 应用程序。当前赠款提案的总体目标是提高对机制的理解 影响遵守当代艾滋病毒治疗方案，并结合与酒精有关 干预新兴策略，以实现和维持潜水员的艾滋病毒抑制 人群。我们建议注册和调查1200名新佛罗里达人队列参与者，有针对性的入学人数 对于饮酒者和性/族裔少数民族。调查数据将使我们能够确定多层次的因素 在饮酒的PWH中有助于艺术依从性和病毒抑制。从总体队列中，80 饮酒的PWH将完成一个月的“增强监测（EM）”。 EM组将戴手腕 酒精生物传感器，报告酒精和其他危险因素（例如，实时动画，抑郁症）和艺术 通过生态瞬时评估（EMA）应用程序遵守，并提供两个干血点（DBS） 病毒载荷测试。 EM数据将有助于消除酒精，其他风险之间的临时关系 实时的因素和艺术依从性。调查和EM数据以及EM参与者的输入将 用于告知基于生物传感器干预的几个方面的发展。我们的跨学科 团队还将定期与新的社区/提供商顾问委员会（CAB）会面，后者将提供意见 与正在进行的佛罗里达人群有关（例如，入学，调查设计），并帮助制定一项计划以整合 基于酒精生物传感器的干预对PL应用程序。具体目的包括：1）系统调查 基于社会生态模型的多层次因素以及影响艺术依从性和的模型 酒精与非使用PWH中的艾滋病毒抑制。 2）在80种酒精的PWH中，使用 酒精生物传感器和EMA数据以识别酒精消耗模式和风险因素最强烈 与ART不遵守和HIV病毒抑制不良有关。 3）开发一种干预措施 将酒精生物传感器纳入现有的MHealth Art依从性干预措施，并从 使用酒精的PWH和社区/提供商顾问委员会。我们在这个项目中收集的丰富信息 将为我们的下一步建立坚实的基础：集成的混合实施/有效性试验 佛罗里达州的大型临床/社区艾滋病毒环境网络中的酒精干预。