Alcohol Research Consortium in HIV: Relapse Prevention Arm

艾滋病毒酒精研究联盟：预防复发部门

• 批准号: 10304376
• 负责人: Heidi Hutton
• 金额: $ 20.04万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10304376
• 关键词: AIDS prevention; Abstinence; Adherence; Adoption; Aftercare; Alcohol consumption; Alcohols; Anxiety; Behavioral Model; Caring; Clinic; Clinical; Clinical Services; Computer software; Computers; Continuity of Patient Care; Diagnosis; Dimensions; Disease remission; Effectiveness; Effectiveness of Interventions; Epidemic; Epidemiology; Feedback; Frequencies; Future; General Population; HIV; Health; Heavy Drinking; Hybrids; Intervention; Interview; Literature; Maintenance; Mental Depression; Methods; Moods; Outcome; Outcome Measure; Participant; Patients; Pattern; Persons; Phase; Population Sizes; Process; Provider; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Relapse; Risk; Testing; Time; Training; United States National Institutes of Health; alcohol abuse therapy; alcohol relapse; alcohol research; alcohol risk; alcohol use disorder; arm; comorbidity; computerized; disorder later incidence prevention; drinking; efficacy implementation trial; evidence base; experience; high risk; implementation fidelity; implementation framework; implementation outcomes; personalized medicine; preventive intervention; programs; recruit; relapse risk; skills; social determinants; social disparities; substance use; success; synergism; therapy development; treatment as usual; treatment services; uptake

At risk alcohol use and alcohol use disorders (AUD) are prevalent among people with HIV (PWH) and cause well-documented harms across the HIV prevention and care continuum. A number of effective person and computer delivered alcohol treatments exist for PWH; however, to date they have largely focused on at- risk alcohol use and do not address the sizeable population of PWH with AUD who are at risk of relapse. Indeed, in the general population, approximately 50-75% of people who stop drinking alcohol relapse within one year, indicating that relapse is a significant part of the alcohol use spectrum. Relapse prevention interventions (RPI) potentially extend the alcohol care continuum by building skills to reduce frequency and intensity of relapse episodes, maintain treatment engagement, and motivate renewed efforts toward drinking reduction. Thus, there is a high clinical need to investigate RPI effectiveness to maintain drinking reductions in PWH and, if effective, to integrate RPI into HIV-CC. We propose a 3-arm type 1 pilot implementation-efficacy trial for PWH with AUD to examine the feasibility and preliminary effectiveness of an adapted 2-session, computerized and person delivered relapse prevention intervention. Our proposed pilot is a NIH Stage 1 Model for behavioral intervention development that defines Stage 1A as intervention adaptation and refinement for new patient groups and settings, and Stage 1B as intervention piloting to test preliminary effectiveness and feasibility/acceptability. Our project has three phases. First, we will adapt a relapse prevention intervention for PWH, train the interventionist for person-delivered administration, and use authoring software to develop the computerized administration. Second, we will recruit and randomize 150 patients who have an AUD diagnosis and who are at risk for alcohol relapse from a large, urban HIV clinic. The three study conditions are computer delivered RPI, person delivered RPI or treatment as usual. Alcohol and HIV outcomes will be assessment for one-year. Third, we will use the RE-AIM implementation framework to evaluate study participants, and clinical and organizational staff with mixed methods to assess barriers and facilitators to RPI integration in the HIV clinical setting. To our knowledge this is the first avatar delivered, evidence-driven intervention developed for alcohol relapse prevention in HIV patients. For long-term success in Ending the HIV Epidemic, it is critical that the alcohol treatment field expand types of clinical services and availability/ease of access within the HIV care continuum. In the future, this will enable a personalized medicine approach to care that more precisely and intensively targets those patients at highest risk of relapse, and thereby optimizes health and quality of life for PWH with AUD.

有风险的酒精使用和酒精使用障碍（AUD）在艾滋病毒感染者（PWH）中普遍存在， 在整个艾滋病毒预防和护理过程中造成有据可查的伤害。一些有效的人 和计算机提供的酒精治疗存在PWH;然而，迄今为止，他们主要集中在- 我们认为，这是一个风险的酒精使用，并没有解决相当大的人口与澳元兑兑美元谁是复发的风险。 事实上，在一般人群中，大约50-75%停止饮酒的人在饮酒后10分钟内复发。 这表明复发是酒精使用谱的重要组成部分。复燃预防 干预措施（RPI）可能会通过培养技能来减少饮酒频率， 复发事件的强度，保持治疗参与，并激励重新努力饮酒 还原因此，临床上非常需要研究RPI有效性，以维持饮酒减少， 威尔斯亲王医院，并在有效的情况下，将RPI纳入艾滋病毒-CC。 我们提出了一个3臂1型试点实施疗效试验的PWH与AUD检查， 适应的2个疗程、计算机化和个人交付的复发的可行性和初步有效性 预防干预。我们建议的试点是一个国家卫生研究院阶段1模型的行为干预发展 将第1A阶段定义为针对新患者群体和环境的干预调整和改进， 第1B阶段为干预试点，以测试初步有效性和可行性/可接受性。我们的项目有 三个阶段。首先，我们会为威尔斯亲王医院采用预防复发的介入措施，培训介入人员， 人员交付管理，并使用创作软件开发计算机化管理。 其次，我们将招募并随机分配150名患有AUD诊断并有酒精风险的患者 从一家大型城市艾滋病诊所复发。三种研究条件是计算机提供的RPI，人 给予RPI或常规治疗。酒精和艾滋病毒的结果将进行为期一年的评估。三是 使用RE-AIM实施框架评估研究参与者、临床和组织人员 采用混合方法评估HIV临床环境中RPI整合的障碍和促进因素。对我们 知识这是第一个化身交付，证据驱动的干预开发酒精复发 艾滋病患者的预防。为了在结束艾滋病毒流行方面取得长期成功， 在艾滋病毒治疗领域，扩大了临床服务的类型，并在艾滋病毒护理连续体中扩大了可获得性/便利性。 在未来，这将使个性化医疗方法能够更精确和更深入地护理 针对那些复发风险最高的病人，从而优化威尔斯亲王医院的健康和生活质量， 澳元。