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

酒精

• 批准号: 7465495
• 负责人: REBECCA K PAPAS
• 金额: $ 10.98万
• 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 2009-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7465495
• 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）：酒精使用和滥用与艾滋病毒感染者中危险性行为增加、抗逆转录病毒治疗（ARV）依从性差和ARV毒性有关。因此，酒精使用和滥用对艾滋病毒传播和疾病进展有重大影响。由于酒精滥用在肯尼亚很普遍，估计危险饮酒高达68%的普通医学诊所和53%的艾滋病毒诊所，我们提出了一个第一阶段的试点项目，以开发和评估一个同行为主导的群体认知行为治疗（CBT），针对艾滋病毒感染的肯尼亚人谁有资格接受抗逆转录病毒治疗的酒精使用。虽然CBT是非常适合肯尼亚的设置，因为它是比较结构化和一致的肯尼亚饮酒行为的概念模型，它需要适应同行交付由于肯尼亚心理健康专业人员的供应极其有限。这项为期24个月的能力建设R21研究的目标是评估CBT的新应用的有效性，这是肯尼亚埃尔多雷特的一个6次会议的同行领导小组，与通常的护理支持小组相比，以减少感染艾滋病毒的成年人中的危险和酗酒。这项工作将通过肯尼亚-美国艾滋病毒和酒精研究和预防伙伴关系（KHARPP）进行-这是一个由肯尼亚和美国医生，行为科学家，康复药物使用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）和退伍军人老龄队列研究（VACS）之间的良好联系，VACS是一项关于艾滋病毒和酒精的纵向临床研究。AMPATH在肯尼亚西部的15家诊所治疗了25,000多名患者。作为这些努力的一部分，我们已经完成了将CBT协议翻译成斯瓦希里语并进行改编，翻译了筛选和结果文书，并量化了当地酿造的饮料的类型和份量。我们的具体目标是：1）培训2名肯尼亚心理学家，使用标准化的依从性/质量评级量表对同伴主导的CBT模型进行持续的质量/忠诚度监测; 2）培训4名肯尼亚同伴促进者进行标准化的CBT干预，以减少酒精使用; 3）通过一个小型的，为期6周的试验中，56名感染艾滋病毒的肯尼亚人被随机分配到同性CBT或常规护理艾滋病毒支持小组。我们的目标与NIAAA的使命一致，即减少弱势群体的酒精使用和艾滋病毒风险，完成这些目标将产生以下产品：（1）英语和斯瓦希里语的CBT干预完整手册，（2）临床医生培训材料和过程评级表，（3）试点研究的效果大小初步指标，以及适用于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是有希望的，这些材料应该足以在肯尼亚的其他艾滋病毒诊所对这一人群进行一项完整的“第二阶段”随机试验。这项研究将确定与通常的护理支持小组相比，在美国证明减少饮酒的有力证据的认知行为干预在肯尼亚是否有效。它将由感染艾滋病毒的个人提供，这些人可能没有受过多少正规教育，但他们接受过标准化干预方法的培训，并敏锐地意识到他们有艾滋病毒感染和酗酒问题的同龄人的需要。这种做法与在资源贫乏的环境中成功的具有成本效益的服务提供模式是一致的，临床官员、传统助产士和同伴咨询员）接受培训。