CHARTZ

项目摘要/摘要 在撒哈拉以南非洲(SSA)，不健康的饮酒和艾滋病毒感染的交集最为明显 在一些人群中，艾滋病毒流行率超过20%，酒精消费呈上升趋势。大多数艾滋病毒治疗 SSA的预防计划没有基于证据的酒精干预和专业的心理干预 卫生人力极其有限。酒精短暂干预(BI)，在 其他设置，在前几次针对HIV感染者中不健康的酒精使用的SSA中都是无效的 审判。不健康的酒精使用往往会因患有精神疾病和/或其他物质使用而复杂化。我们 以前证明了跨诊断模式的可行性、可接受性和潜在的有效性 被称为常见元素治疗方法(CETA)，适用于艾滋病毒携带者和不健康的饮酒者。CETA 专为非专业人员(非专业人员，以前精神健康状况有限或没有心理健康)提供服务 经验)，并可以在单一协议内解决一系列情况(包括不健康的饮酒 提供超过6-12个疗程的治疗。CETA在之前的3个随机试验中进行了评估，发现 对受创伤影响和边缘化人群的一系列疾病有效。CETA HIV减少酒精排放 赞比亚试验(Chartz)，这是赞比亚阿拉巴马州艾滋病毒-酒精共病计划内的一个研究项目， 是一项评估CETA和一种新型酒精BI对艾滋病毒影响的混合有效性实施试验， 酒精和共病结果。成年人(18岁以上)感染艾滋病毒，不健康饮酒，不适宜饮酒 卢萨卡公共部门艾滋病毒诊所的艾滋病毒护理参与度将被登记并随机分配到标准 护理(艺术坚持咨询)，BI单独，或BI加CETA。BI和CETA将由HIV Peer提供 教育者，扎根在赞比亚各地艾滋病诊所的非专业顾问干部。患者报告的结果 措施(酒精使用、精神疾病和其他物质使用)和艾滋病毒电子病历(针对ART 坚持、保留艾滋病毒护理、病毒抑制)将用于评估试验资格和结果 在6个月和12个月时。将对直接酒精生物标志物磷脂酰乙醇进行测量，以加强评估 试验结果。将评估与CETA和BI综合交付有关的实施因素 包括成本和成本效益。总而言之，查茨将提出心理治疗的证据 对于在低资源环境中有很大实施潜力的不健康酒精使用，可以解决 破坏艾滋病毒治疗和预防的复杂和重叠的行为问题。

Project Summary/Abstract The intersection of unhealthy alcohol use and HIV infection is most significant in sub-Saharan Africa (SSA) where HIV prevalence exceeds 20% in some populations and alcohol consumption is on the rise. Most HIV treatment and prevention programs in SSA do not have evidence-based alcohol interventions and the professional mental health workforce is extremely limited. Alcohol brief interventions (BI), which have been moderately effective in other settings, were not effective in SSA for unhealthy alcohol use among people with HIV in several previous trials. Unhealthy alcohol use is often complicated by comorbid mental illness and/or other substance use. We previously demonstrated the feasibility, acceptability, and potential effectiveness of a transdiagnostic model called Common Elements Treatment Approach (CETA) for people with HIV and unhealthy alcohol use. CETA was designed for delivery by lay providers (non-professionals with limited or no previous mental health experience) and can address a range of conditions (including unhealthy alcohol use) within a single protocol delivered over 6-12 therapy sessions. CETA was evaluated in 3 previous randomized trials and found to be effective for a range of conditions in trauma-affected and marginalized populations. CETA HIV Alcohol Reduction Trial in Zambia (CHARTZ), a research project within the Zambia Alabama HIV Alcohol Comorbidities Program, is a hybrid effectiveness-implementation trial to evaluate the effects of CETA, and a novel alcohol BI, on HIV, alcohol, and comorbidity outcomes. Adults (18+ years old) with HIV, unhealthy alcohol use, and suboptimal engagement in HIV care at public sector HIV clinics in Lusaka will be enrolled and randomized to the standard of care (ART adherence counseling), BI alone, or BI plus CETA. The BI and CETA will be provided by HIV peer educators, a cadre of lay counselors who are embedded at HIV clinics across Zambia. Patient reported outcome measures (for alcohol use, mental illness, and other substance use) and HIV electronic medical records (for ART adherence, retention in HIV care, viral suppression) will be used to assess trial eligibility and evaluate outcomes at 6 and 12 months. Phosphatidylethanol, a direct alcohol biomarker, will be measured to strengthen assessment of trial outcomes. Implementation factors related to the integrated delivery of CETA and the BI will be evaluated including cost and cost effectiveness. In summary, CHARTZ will generate evidence on psychological treatments for unhealthy alcohol use that have strong potential for implementation in low-resource settings and can address complex and overlapping behavioral issues that undermine HIV treatment and prevention.