Alcohol & HIV in Kenya: Stage 1 Trial of a Peer-led Alcohol Behavior Intervention

酒精

• 批准号: 7279622
• 负责人: REBECCA K PAPAS
• 金额: $ 15.5万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-10 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7279622
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Adult; Aging; Alcohol abuse; Alcohol consumption; Alcohols; Behavior Therapy; Behavioral; Biological Markers; CD4 Lymphocyte Count; Caring; Catchment Area; Certification; Clinic; Clinical; Clinical Research; Cognitive; Cognitive Therapy; Cohort Studies; Collaborations; Competence; Disease Progression; Education; Goals; HIV; HIV Infections; Health Professional; Indiana; Individual; Intervention; Kenya; Manuals; Maps; Measures; Medicine; Mental Health; Methods; Mission; Modeling; Monitor; Outcome; Patients; Personal Satisfaction; Persons; Physicians; Pilot Projects; Population; Prevention; Process; Professional counselor; Protocols documentation; Provider; Psychologist; Randomized; Randomized Controlled Clinical Trials; Rate; Research; Research Ethics Committees; Resources; Risk; Risk Behaviors; Role playing therapy; Saliva; Scientist; Screening procedure; Services; Staging; Standards of Weights and Measures; Structure; Supervision; Support Groups; Toxic effect; Traditional Birth Attendants; Training; Translations; Universities; Veterans; Vulnerable Populations; Weight; Work; World Health Organization; alcohol behavior; alcohol research; alcohol testing; antiretroviral therapy; binge drinking; cost; day; depressive symptoms; drinking; drinking behavior; experience; high risk sexual behavior; instrument; medical schools; novel; peer; sex; size; transmission process; week trial

DESCRIPTION (provided by applicant): Alcohol use and abuse have been associated with increased risky sexual behavior, poor adherence to antiretroviral therapy (ARVs) and toxicity from ARVs among those with HIV infection. As such, alcohol use and abuse have a major impact on HIV transmission and disease progression. Because alcohol abuse is widespread in Kenya, with estimates of hazardous drinking as high as 68% in general medicine clinics and 53% in HIV clinics, we propose a Stage 1 pilot project to develop and evaluate a peer-led group cognitive behavioral treatment (CBT) targeting alcohol use among HIV infected Kenyans who are eligible for ARV therapy. Although CBT is well-suited to the Kenyan setting because it is comparatively structured and consistent with the Kenyan conceptual model of drinking behavior, it requires adaptation for peer delivery due to the extremely limited supply of Kenyan mental health professionals. The goal of this 24-month capacity- building R21 study is to evaluate the efficacy of a novel application of CBT, a 6-session peer-led group in Eldoret, Kenya, when compared against a usual care support group, to reduce hazardous and binge drinking among adult persons infected with HIV. This work will be conducted via the Kenya-U.S. HIV and Alcohol Research and Prevention Partnership (KHARPP)-an experienced team of Kenyan and U.S. physicians, behavioral scientists, recovered substance users and persons infected with HIV. KHARPP expands on well- established ties between the Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) and the Veterans Aging Cohort Study (VACS), a longitudinal clinical study of HIV and alcohol. AMPATH treats more than 25,000 patients in 15 clinics in western Kenya. As a part of these efforts, we have already completed translation to Kiswahili and adaptation of the CBT protocol, translation of the screening and outcome instruments, and the quantification of types and serving sizes of locally brewed drinks. Our specific aims are to: 1) train 2 Kenyan psychologists to provide ongoing quality/fidelity monitoring of the peer-led CBT model using standardized adherence/quality rating scales; 2) train 4 Kenyan peer facilitators in the standardized CBT intervention to reduce alcohol use; and 3) evaluate the feasibility of the peer-led group CBT intervention via a small, 6-week trial in which 56 HIV infected Kenyans are randomized to same-sex CBT or usual care HIV support groups. Completion of our objectives, which are consistent with NIAAA's mission to reduce both alcohol use and HIV risk in vulnerable populations, will result in the following products: (1) a complete manual for the CBT intervention in both English and Kiswahili, (2) clinician training materials and process rating forms, (3) preliminary indicators of effect size from the pilot study, and well as adapted alcohol-related assessment instruments for this setting and population. If the CBT intervention is demonstrated to have promise in this Stage 1 study, these materials should be sufficient to develop a full "Stage 2" randomized trial with this population to be implemented at additional HIV clinics in Kenya. This study will determine whether a cognitive behavioral intervention that demonstrates strong evidence in the U.S. of reducing alcohol use is effective in Kenya, when compared against a usual care support group. It will be delivered by individuals who are infected with HIV and may have little formal education but who are trained in standardized intervention methods and keenly aware of the needs of their peers with HIV infection and alcohol problems. This approach is consistent with successful cost-effective models of service delivery in resource-poor settings in which lay individuals (e.g., clinical officers, traditional birth attendants and peer counselors) are trained.

描述（由申请人提供）：在 HIV 感染者中，饮酒和滥用酒精与危险性行为增加、抗逆转录病毒治疗 (ARV) 依从性差以及 ARV 毒性有关。因此，饮酒和滥用酒精对艾滋病毒传播和疾病进展具有重大影响。由于酗酒在肯尼亚很普遍，估计普通医学诊所的危险饮酒率高达 68%，艾滋病毒诊所的危险饮酒率高达 53%，因此我们提出了一个第一阶段试点项目，以开发和评估同伴主导的团体认知行为治疗 (CBT)，针对有资格接受抗逆转录病毒治疗的艾滋病毒感染肯尼亚人的饮酒情况。尽管 CBT 非常适合肯尼亚的环境，因为它相对结构化且符合肯尼亚饮酒行为的概念模型，但由于肯尼亚心理健康专业人员的供应极其有限，它需要适应同伴传递。这项为期 24 个月的能力建设 R21 研究的目标是评估 CBT（肯尼亚埃尔多雷特的一个为期 6 次的同伴主导小组）的新应用与常规护理支持小组相比的有效性，以减少感染艾滋病毒的成年人中的危险饮酒和酗酒。这项工作将通过肯尼亚-美国进行艾滋病毒和酒精研究与预防合作伙伴关系 (KHARPP)——一个由肯尼亚和美国医生、行为科学家、戒毒者和艾滋病毒感染者组成的经验丰富的团队。 KHARPP 扩展了艾滋病毒/艾滋病预防和治疗学术模型 (AMPATH) 与退伍军人老龄队列研究 (VACS) 之间已建立的联系，后者是一项针对艾滋病毒和酒精的纵向临床研究。 AMPATH 在肯尼亚西部的 15 个诊所为超过 25,000 名患者提供治疗。作为这些努力的一部分，我们已经完成了斯瓦希里语的翻译和 CBT 协议的改编、筛选和结果工具的翻译以及本地酿造饮料的类型和份量的量化。我们的具体目标是：1）培训 2 名肯尼亚心理学家，使用标准化依从性/质量评级量表对同行主导的 CBT 模型进行持续的质量/保真度监控； 2) 对 4 名肯尼亚同伴协调员进行标准化 CBT 干预培训，以减少饮酒； 3) 通过一项为期 6 周的小型试验评估同伴主导的团体 CBT 干预的可行性，其中 56 名感染 HIV 的肯尼亚人被随机分入同性 CBT 或常规护理 HIV 支持小组。我们的目标与 NIAAA 减少弱势群体饮酒和艾滋病毒风险的使命相一致，我们的目标的完成将产生以下产品：(1) 英语和斯瓦希里语 CBT 干预的完整手册，(2) 临床医生培训材料和过程评级表，(3) 试点研究效果大小的初步指标，以及针对该环境和人群的酒精相关评估工具。如果 CBT 干预在第一阶段研究中被证明有希望，那么这些材料应该足以针对该人群开展完整的“第二阶段”随机试验，并在肯尼亚其他艾滋病毒诊所实施。这项研究将确定与常规护理支持小组相比，在美国证明减少饮酒的强有力证据的认知行为干预措施在肯尼亚是否有效。它将由艾滋病毒感染者提供，他们可能没有接受过正规教育，但接受过标准化干预方法的培训，并且敏锐地意识到患有艾滋病毒感染和酗酒问题的同龄人的需求。这种方法与资源匮乏环境中成功的、具有成本效益的服务提供模式是一致的，在这些模式中，非专业人员（例如临床官员、传统助产士和同伴咨询师）接受培训。