HealthCall: Enhancing brief intervention for HIV primary care alcohol dependence

HealthCall：加强对艾滋病毒初级保健酒精依赖的短期干预

• 批准号: 8731034
• 负责人: DEBORAH S HASIN
• 金额: $ 77.83万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-25 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8731034
• 关键词: Address; Affect; Aftercare; Alcohol dependence; Alcohols; Attention; Caring; Characteristics; Client satisfaction; Clinic; Clinical; Communication; Continuity of Patient Care; Cost Analysis; Counseling; Data; Enhancers; Epidemic; Evidence based intervention; Feedback; HIV; Health; Health Benefit; Health Personnel; Health behavior; Health education; Heavy Drinking; Human Resources; Intervention; Liver; Liver diseases; Mediating; Medical; Minority; Monitor; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Positioning Attribute; Primary Health Care; Provider; Public Health; Reaction; Relative (related person); Reporting; Research; Risk; Self Efficacy; Site; Smoking; Supervision; Techniques; Technology; Testing; Time; Training; Update; Viral Load result; Work; addiction; alcohol intervention; antiretroviral therapy; arm; base; brief intervention; comparative efficacy; cost; design; drinking; evidence base; experience; follow-up; forgetting; improved; indexing; innovation; mortality; motivational enhancement therapy; primary outcome; public health relevance; randomized trial; secondary outcome; skills; theories; therapy adherence; treatment effect; trial comparing

DESCRIPTION (provided by applicant): Among those with HIV, heavy drinking predicts poor antiretroviral therapy (ART) adherence, and substantially increases mortality and morbidity through harmful effects on the liver. Thus, effective and scalable drinking interventions are urgently needed to improve the health and survival of heavy-drinking HIV patients. Brief drinking interventions in non-dependent general primary care patients are effective, but alcohol dependent patients need more extensive intervention. Tested drinking-reduction interventions for HIV populations require considerable personnel time. To extend brief intervention in the HIV clinic with little extra demand on staff time, we harnessed communication technology to develop HealthCall, an innovative enhancement of brief drinking- reduction intervention for urban HIV patients. HealthCall uses technology to engage patients in brief daily self- monitoring of drinking, ART adherence, and other health behaviors over 60 days. The self-monitoring data are then summarized for patients, providing personalized feedback for brief review and discussion at 30 and 60 days. Patient satisfaction with HealthCall is high. Importantly, in urban alcohol dependent HIV primary care patients, we showed that HealthCall is effective at reducing heavy drinking when paired with brief Motivational Interviewing (MI; MI+HealthCall). Since then, formative work also indicated ways to increase HealthCall focus on antiretroviral therapy (ART) adherence. MI is theory-driven, evidence-based, and effective, but requires careful training, supervision and skill for successful outcome. Pairing HealthCall with a more scalable brief intervention would offer wider public health benefits. NIAAA recommends the Clinician's Guide (CG) as a brief, evidence-based approach to alcohol intervention for health care personnel who do not have counseling backgrounds. Compared to MI, CG requires less training and specific skills, thus potentially lowering costs and improving scalability when paired with HealthCall. CG also can readily incorporate attention to ART adherence. We propose a randomized trial to compare MI+HealthCall, CG+HealthCall and CG-only in 300 English- or Spanish-speaking alcohol dependent HIV patients at three diverse urban HIV clinics. The primary outcome is drinking reduction. Important secondary outcomes are ART adherence, viral load, and retention in HIV care, smoking, and the relative cost of each intervention. We will also explore if treatment effects on drinking are moderated by site or patient characteristics, and mediated by theoretically based mechanisms (commitment to change; self-efficacy). Durability of effects will be assessed through 12-month follow-up. Our scientific team has expertise in alcohol, ART adherence, technology-based brief interventions, and cost analysis, and is thus well positioned for a successful study. Responding to PA-13-121, this study will provide information on the efficacy of HealthCall to reduce drinking in HIV alcohol dependent patients when paired with two brief, evidence-based interventions that differ in their potential for scalability, addressing the need for innovative yet evidence-based brief interventions to improve the health and survival of alcohol dependent HIV patients.

描述（由申请人提供）：在 HIV 感染者中，大量饮酒预示着抗逆转录病毒治疗 (ART) 依从性较差，并且通过对肝脏的有害影响而大大增加死亡率和发病率。因此，迫切需要有效且可扩展的饮酒干预措施来改善酗酒艾滋病毒患者的健康和生存。对非酒精依赖的普通初级保健患者进行短暂的饮酒干预是有效的，但酒精依赖的患者需要更广泛的干预。经过测试的针对艾滋病毒人群的减少饮酒干预措施需要大量的人员时间。为了在不增加工作人员时间的情况下延长艾滋病毒诊所的短暂干预，我们利用通信技术开发了 HealthCall，这是针对城市艾滋病毒患者的短期减少饮酒干预的创新增强。 HealthCall 使用技术让患者在 60 天内对饮酒、ART 依从性和其他健康行为进行简短的日常自我监测。然后为患者总结自我监测数据，提供个性化反馈，以便在 30 天和 60 天时进行简短回顾和讨论。患者对 HealthCall 的满意度很高。重要的是，在城市酒精依赖型艾滋病毒初级保健患者中，我们发现 HealthCall 与简短的动机访谈（MI；MI+HealthCall）相结合可有效减少酗酒。从那时起，形成性工作还指出了如何加强 HealthCall 对抗逆转录病毒治疗 (ART) 依从性的关注。 MI 是理论驱动、基于证据且有效的，但需要仔细的培训、监督和技能才能取得成功。将 HealthCall 与更具可扩展性的简短干预相结合将带来更广泛的公共卫生益处。 NIAAA 推荐临床医生指南 (CG) 作为一种针对没有咨询背景的医护人员进行酒精干预的简短、循证的方法。与 MI 相比，CG 需要较少的培训和特定技能，因此与 HealthCall 配合使用时可能会降低成本并提高可扩展性。 CG 还可以轻松地将对 ART 依从性的关注纳入其中。我们提出了一项随机试验，对三个不同城市 HIV 诊所的 300 名讲英语或西班牙语的酒精依赖 HIV 患者进行 MI+HealthCall、CG+HealthCall 和仅 CG 比较。主要结果是减少饮酒。重要的次要结果是 ART 依从性、病毒载量、HIV 护理保留率、吸烟以及每种干预措施的相对成本。我们还将探讨是否可以治疗 对饮酒的影响受到场所或患者特征的调节，并受到基于理论的机制（改变的承诺；自我效能）的调节。效果的持久性将通过 12 个月的随访进行评估。我们的科学团队在酒精、ART 依从性、基于技术的简短干预和成本分析方面拥有专业知识，因此为成功的研究做好了充分的准备。针对 PA-13-121，本研究将提供有关 HealthCall 与两种简短的循证干预措施（其可扩展性潜力不同）配合使用时减少 HIV 酒精依赖患者饮酒的功效的信息，满足创新的需求基于证据的简短干预措施，以改善酒精依赖的艾滋病毒患者的健康和生存。