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

基本信息

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
项目类别：
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

项目摘要

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）：在患有艾滋病毒的患者中，大量饮酒可预测抗逆转录病毒疗法（ART）依从性不佳，并通过对肝脏的有害影响大大提高了死亡率和发病率。因此，迫切需要采取有效且可扩展的饮酒干预措施，以改善重饮HIV患者的健康和存活。非依赖性普通初级保健患者的简短饮酒干预措施有效，但依赖酒精的患者需要更广泛的干预措施。对艾滋病毒群体的减少饮酒干预措施需要大量人员时间。为了扩大对艾滋病毒诊所的短暂干预，对员工时间的额外需求很少，我们利用了通信技术来开发医疗服务，这是对城市艾滋病毒患者的短暂饮酒干预措施的创新增强。 HealthCall使用技术在60天内对患者进行简短的每日自我监测，对饮酒，艺术依从性和其他健康行为的自我监测。然后，为患者总结了自我监控数据，为30和60天提供了个性化的反馈，以简要审查和讨论。患者对医疗服务的满意度很高。重要的是，在依赖城市酒精的艾滋病毒初级保健患者中，我们表明医疗通道在与短暂的动机访谈（MI; MI; MI+Healthcall）配对时有效减少大量饮酒。从那时起，形成性工作还指出了增加医疗服务对抗逆转录病毒疗法（ART）依从性的方法。 MI是理论驱动的，基于证据的和有效的，但需要仔细的培训，监督和成功的结果。将HealthCall与更可扩展的简短干预配对将为更广泛的公共卫生福利提供。 NIAAA建议临床医生指南（CG）作为对没有咨询背景的卫生保健人员的简短，基于证据的饮酒方法。与MI相比，CG需要更少的培训和特定技能，从而有可能降低成本并与HealthCall配对时提高可扩展性。 CG还可以很容易地关注对艺术依从性的关注。我们提出了一项随机试验，以比较三种不同的城市HIV诊所的MI+HealthCall，CG+HealthCall和仅CG的仅300名英语或西班牙酒精依赖的HIV患者。主要结果是减少饮酒。重要的次要结果是艺术依从性，病毒载荷和艾滋病毒护理，吸烟和每种干预的相对成本的保留。我们还将探索是否治疗对饮酒的影响由现场或患者特征进行调节，并由理论上的机制（对改变；自我效能）进行介导。效果的耐用性将通过12个月的随访进行评估。我们的科学团队在酒精，艺术依从性，基于技术的简短干预措施和成本分析方面拥有专业知识，因此可以很好地进行研究。为了应对PA-13-121，这项研究将提供有关医疗通道与两种简短的基于循证的干预措施相比，医疗饮酒的疗效，以减少艾滋病毒依赖的患者的饮酒，这些干预措施在其潜在的可伸缩性上有所不同，从而满足了需要创新但基于证据的简短干预措施，以改善酒精依赖性HIV患者的健康和存活。