SUPPORTING ALCOHOL REDUCTION IN HIV+ PATIENTS: A TRAINING FOR HIV CARE PROVIDERS

描述(由申请者提供)：本申请旨在为艾滋病毒护理提供者开发和评估理论驱动的培训，以支持他们系统地使用国家酒精滥用和酒精中毒研究所的有效短暂干预(NIAAA的B1)来减少酒精。艾滋病毒感染者和艾滋病毒/丙型肝炎病毒混合感染者中高风险饮酒率，以及这种饮酒往往在以下方面造成的严重危害：(A)加速疾病进展，(B)限制抗逆转录病毒治疗的有效性和获得机会，以及(C)有时增加严重危害他们及其伴侣健康的危险性行为，这为开展这项研究提供了理由和紧迫性。尽管提供者处于独特的地位，可以将戒酒作为“积极预防”的一部分，对患者进行筛查和咨询，但他们很少这样做，这往往是由于经验、技能和自我效能有限的结果。因此，迫切需要一个提供者培训来实施NIAAA的BL，正如我们的初步研究表明的那样，艾滋病毒护理提供者有兴趣接受这样的培训，并表示他们将把他们学到的BL技能付诸实践。因此，在社会认知理论和辛普森的组织变革模型的指导下，发展性研究的目标是(1)创建一个最先进的提供者培训，通过教授参与者(A)如何筛选患者是否饮酒，以及(B)如何利用动机访谈的原则有效地建议他们减少饮酒，来鼓励实施NIAAA的B1；(2)在纽约市4个指定的艾滋病中心进行培训，以获得培训后立即、1个月和4个月后培训对提供者的影响的初步数据，包括他们的知识、态度、自我效能、集体组织效能和实际使用NIAAA的Bl；以及(3)获得初步数据，以检查提供者培训对以下方面的影响：(A)患者减少饮酒；(B)艾滋病毒提供者组织，(I)应对酒精和艾滋病毒/丙型肝炎病毒/艾滋病毒混合感染的组织氛围；和(2)本组织实际扩大现有的减酒服务和/或实施新的服务以减少饮酒。如果结果显示培训是有用的、可行的、可接受的和有效的，以填补艾滋病毒患者的关键服务缺口，我们将申请拨款，在不同的地点进一步检查其有效性，并广泛传播培训。

DESCRIPTION (provided by applicant): This application aims to develop and evaluate a theory-driven training for HIV care providers to support their systematic use of the National institute on Alcohol Abuse and Alcoholism's effective brief intervention (NIAAA's Bl) for alcohol reduction. The high rate of at-risk alcohol use among individuals with HIV and HIV/HCV co-infection, and the serious harm that such alcohol use often causes in (a) accelerating disease progression, (b) limiting effectiveness and access to ARV therapy, and (c) sometimes increasing risky sexual behaviors that seriously jeopardize their health and that of their partners, provides the rationale and urgency for this research. Although providers are uniquely positioned to screen and counsel patients about alcohol reduction as part of a "prevention with positive" focus, they rarely do, often as a result of limited experience, skills, and self-efficacy. Thus, a provider training to implement NIAAA's Bl is critically needed, and, as our preliminary studies indicate, HIV care providers are interested in receiving such a training and indicate they would put the Bl skills they learn into practice. Thus, guided by Social Cognitive Theory and Simpson's Model of Organizational Change, the aims of the proposed developmental study are to (1) create a state-of-the-art provider training to encourage the implementation of NIAAA's Bl by teaching participants (a) how to screen patients for alcohol use, and (b) how to effectively counsel them to reduce this use using the principles of motivational interviewing; (2) to implement the training in 4 Designated AIDS Centers in New York City to obtain preliminary data regarding the impact of the training on providers immediately post-training, and 1- and 4- months post- training with regard to their knowledge, attitudes, self-efficacy, collective organizational efficacy, and actual use of NIAAA's Bl; and (3) to obtain preliminary data in order to examine the impact of the provider training on (a) patients' alcohol reduction; and on (b) the HIV provider organization, in terms of (i) the organizational climate towards dealing with alcohol and HIV and HIV/HCV co-infection; and (ii) the organization's actual expansion of existing alcohol reduction services and/or the implementation of new services to reduce alcohol consumption. If results demonstrate that the training is useful, feasible, acceptable, and effective in filling a critical service gap for HIV patients, we will seek funding to further examine its effectiveness in a variety of venues and to disseminate the training widely.