Using Telehealth to Address Alcohol Misuse in HIV Care

项目摘要 在艾滋病毒感染者（PLWH）中，酒精滥用与减少对 抗逆转录病毒治疗和降低艾滋病毒抑制的几率，以及肝脏和神经认知功能 功能障碍、心血管疾病、癌症、全身性炎症和存活率降低。行为 干预措施可以显著减少艾滋病毒携带者的饮酒，增加安全套的使用，增加抗逆转录病毒治疗， 坚持，并减少艾滋病毒载量。我们最近发现，动机面试（MI）与助推器 与通常的艾滋病毒护理相比，6个月的治疗导致饮酒量大幅减少 经过12个月的随访，这些细胞得到了良好的维护，并且已经过生化验证。然而，在这方面， 提供MI需要训练有素的工作人员进行反复的咨询，这是一种不太可能的资源。 在大多数社区卫生中心都可以获得。在我们最近的工作中，我们发现， 通过视频会议和电话以高保真度提供管理信息是可行的 辅导员的集中核心我们进一步发现，通过视频进行的扩展咨询 或电话和互动短信显示出进一步减少饮酒和增加 HIV病毒抑制的几率。拟议研究的目的是测试现实世界的有效性， ReACH（减少艾滋病护理中的酒精使用和相关并发症）远程健康咨询协议 实用混合1型有效性实施随机试验。我们会招募600名酗酒者 PLWH来自美国地理上不同地区的四个联邦合格的健康中心， 为14，000多名艾滋病毒携带者提供服务。完成入组后，受试者将随机接受 通过电话进行单次简短干预（BI），适当时转诊至当地治疗，或BI + Reach远程健康咨询（TC）。参与者将在24个月后完成随访。 基线，以评估饮酒和健康结果的长期变化。我们将检验TC 与BI相比，将导致（a）每周饮酒量减少和大量饮酒的频率降低 和（B）在12个月和24个月随访时具有不可检测的病毒载量的几率增加。二次 结果包括自我报告的ART依从性，与非排他性伴侣进行无避孕套性行为， 其他物质使用频率、磷脂酰乙醇水平（近期饮酒的生物标志物），以及 退伍军人老龄化队列研究指数评分。我们还将研究TC有效性的潜在调节因素。作为 作为第二个目标，我们将评估与“动态”各方面相对应的执行措施， 可持续性框架，并审查实施结果的可接受性、适当性和 在普罗克特的实施成果框架指导下，因此，这一务实的混合1型试验 将有助于建立ReACH TC干预的实际有效性，同时还提供关键的 与实施相关的措施和成果，将为未来ReACH TC的规模扩大和可持续性提供信息。

Project Summary Among people living with HIV (PLWH), alcohol misuse has been associated with reduced adherence to antiretroviral therapy and decreased odds of HIV viral suppression, as well as liver and neurocognitive dysfunction, cardiovascular disease, cancer, systemic inflammation, and decreased survival. Behavioral interventions can significantly reduce drinking in PLWH as well as increase condom use, increase ART adherence, and decrease HIV viral load. We recently found that motivational interviewing (MI) with booster sessions through 6 months, compared to HIV care as usual, results in particularly large reductions in drinking that are well-maintained over a 12-month follow-up and have been validated biochemically. However, delivering MI requires trained staff to conduct repeated sessions of counseling, a resource that is unlikely to be available at most community health centers caring for PLWH. In our recent work, we have found that it is feasible to deliver MI by videoconferencing and telephone with high fidelity using a resource-efficient centralized core of counselors. We further have found that a combination of both extended counseling by video or telephone and interactive text messaging shows promise in further reducing drinking and in increasing the odds of HIV viral suppression. The purpose of the proposed study is to test the real-world effectiveness of the ReACH (Reducing Alcohol use and related Comorbidities in HIV care) telehealth counseling protocol in a pragmatic Hybrid Type 1 effectiveness-implementation randomized trial. We will recruit 600 heavy-drinking PLWH from four federally-qualified health centers in geographically distinct regions across the U.S, which provide services to over 14,000 PLWH. Upon completing enrollment, participants will be randomized to receive either single-session brief intervention (BI) by phone with referral to local treatment when appropriate or BI plus referral to ReACH telehealth counseling (TC). Participants will complete follow-ups through 24 months after baseline to assess longer-term changes in drinking and health outcomes. We will test the hypothesis that TC compared to BI will result in (a) reduced number of drinks consumed per week and frequency of heavy drinking and (b) increased odds of having an undetectable viral load at 12- and 24-month follow-ups. Secondary outcomes include self-reported ART adherence, engagement in condomless sex with non-exclusive partners, frequency of other substance use, phosphatidylethanol levels (a biomarker of recent alcohol use), and Veterans Aging Cohort Study index scores. We also will examine potential moderators of TC effectiveness. As a secondary aim, we will assess implementation measures corresponding to aspects of the Dynamic Sustainability Framework and examine implementation outcomes of acceptability, appropriateness, and feasibility guided by Proctor’s Implementation Outcomes Framework. Thus, this pragmatic Hybrid Type 1 trial will help establish the real-world effectiveness of the ReACH TC intervention while also providing key implementation-related measures and outcomes that will inform future ReACH TC scale up and sustainability.