Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV

项目概要/摘要 不健康的饮酒和慢性疼痛是艾滋病毒感染者常见的并发症 （PLWH）每一种都对身体和精神功能、艾滋病毒相关结果产生负面影响， 另卫生保健提供者面临着许多挑战，以解决这些经常同时发生的 PLWH的条件，包括有限的时间和资源，药物治疗的局限性， 充分治疗这两种疾病（特别是那些与其他共同发生的医疗条件，或 物质使用史），以及患者对推荐的非药物治疗的依从性差。 尽管有一些得到实践支持的行为方法可以解决所有这些问题， 在某些情况下，他们往往需要多次会议，亲自干预。这些要求对 艾滋病病毒携带者可能面临耻辱和交通、儿童保育等方面的巨大经济挑战， 错过工作。当考虑多种疾病的治疗时，这些挑战变得更加复杂。给定 艾滋病毒携带者慢性疼痛和酗酒的比率，它们对日常功能的综合影响， 艾滋病毒的结果，和可用的治疗限制，将有相当大的好处， 行为的方法，以解决这些共病条件的方式，可以很容易地利用患者。 在我们之前的工作中，我们已经开发了一种综合的行为视频远程医疗干预，旨在减少 不健康的酒精使用和慢性疼痛。这种干预，动机和认知 酒精使用和疼痛管理的行为治疗（MCBMAP）是一个7节整合 通过远程保健提供干预，并辅以网站上提供的材料。的 根据定性访谈为艾滋病毒携带者量身定制的干预措施已被证明具有较高的 患者可接受性，并易于通过智能手机交付。目前的研究旨在测试 在一项全面的随机对照研究中， 在PLWH中进行的一项试验，在6个月的结果中比较了MCBMAP与简要建议和信息条件。 此外，本项目还将通过自我报告来考察干预的主持人和调解人 问卷调查，并通过使用生态瞬时评估（EMA）进行之前和之后， 治疗这些EMA方法将使我们能够检查如何通过干预的过程 可以减少不健康的饮酒和疼痛，并提供洞察疼痛，不健康的 饮酒和功能性结果。

PROJECT SUMMARY/ABSTRACT Unhealthy drinking and chronic pain are common co-occurring conditions among people living with HIV (PLWH) each of which negatively influences physical and mental functioning, HIV-related outcomes, and one another. Health care providers face a number of challenges to addressing these frequently co-occurring conditions for PLWH including restricted time and resources, limitations of pharmacological treatments to adequately treat both conditions (particularly among those with other co-occurring medical conditions or substance use histories), and poor patient adherence to recommended non-pharmacological treatments. Although there are empirically-supported behavioral approaches to address the full spectrum of each of these conditions, they often require multiple session, in-person interventions. Such requirements are burdensome to PLWH, who may face stigma and considerable economic challenges regarding transportation, child-care, and missed work. These challenges are compounded when considering treatments for multiple conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be easily utilized by patients. In our prior work, we have developed an integrated behavioral video telehealth intervention designed to reduce unhealthy alcohol use and chronic pain among PLWH. This intervention, Motivational and Cognitive Behavioral Treatment for the Management of Alcohol Use and Pain (MCBMAP) is a 7-session integrated intervention that is delivered through telehealth and supplemented with materials available on a website. The intervention, which was tailored for PLWH based on qualitative interviews, has been shown to have high patient acceptability and be readily delivered through smartphones. The current study seeks to test the efficacy of this intervention for reducing unhealthy drinking and chronic pain in a fully-scaled, randomized controlled trial among PLWH that compares MCBMAP to a Brief Advice and Information condition at 6-month outcomes. In addition, this project will examine moderators and mediators of intervention through self-report questionnaires and through the use of ecological momentary assessment (EMA) conducted before and after treatment. These EMA methods will allow us to examine how the processes through which the intervention may reduce unhealthy drinking and pain as well as provide insight into the association between pain, unhealthy drinking, and functional outcomes in this population.