Centralized Off-Site Adherence Enhancement Program

集中式场外依从性增强计划

• 批准号: 8473197
• 负责人: HONGHU LIU
• 金额: $ 20.71万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-15 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8473197
• 关键词: Abstinence; Address; Adherence; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anti-Retroviral Agents; Behavioral; Boxing; Clinic; Clinical Trials; Cognitive; Cognitive Therapy; Communication; Counseling; Coupled; Data; Development; Devices; Dose; Drug usage; Electronics; Event; Failure; Funding; Goals; HIV; HIV Seropositivity; Hour; Information Technology; Internet; Intervention; Interview; Logistics; Manuals; Measures; Mechanics; Mediation; Medical; Modification; Monitor; Opiates; Opioid Rotation; Outcome; Patients; Pharmaceutical Preparations; Procedures; Professional counselor; Provider; Psychological reinforcement; Publishing; Randomized; Randomized Controlled Trials; Schedule; Services; Site; Specific qualifier value; Staging; Substance abuse problem; Substance of Abuse; System; Telephone; Testing; Text; Time; Training; Viral Load result; Visit; antiretroviral therapy; arm; base; contingency management; cost effective; discounting; effective intervention; follow-up; improved; intervention program; medication compliance; novel; operation; payment; pill; prevent; programs; reduced substance use; stimulant misuse; therapy development; transmission process; usability; web site

DESCRIPTION (provided by applicant): Patients who use drugs or alcohol who do not adequately adhere to antiretroviral medication have sub-optimal outcomes, but effective interventions for them are lacking. In this R34 application, we seek to develop and pilot an intervention program delivered by phone and supported by information technology that combines contingency management for medication adherence and a cognitive-behavioral approach to both adherence to antiretroviral therapy and abstinence from substances of abuse. The intervention, CARE (Centralized Off-site AdheRence Enhancement Program), builds on the published finding that adherence was robustly improved and viral load was significantly reduced among patients who received cash-reinforcement for opening MEMS- capped bottles to take prescribed medication on time. CARE involves transmission of bottle-opening data with real time operation from SimPill bottles to a website system which generates messages to patients indicating the amount of cash-reinforcement earned if medication was taken within a specified time window or forsaken if medication was missed. Reinforcement for medication-taking will be wired to debit cards that patients will be given to receive the payments. This contingent reinforcement of medication-taking will be coupled with twelve sessions of cognitive-behavioral therapy (CBT) conducted by phone, also assisted by the website which will generate CBT-related text messages, reminders and scheduling information from a menu of choices negotiated by the patient and therapist. Development of CARE will proceed in three stages, with revisions of the intervention at each stage. First, the web system and therapy manuals will be developed. Second, twelve weeks of CARE will be pre-piloted in 10 patients with sub-optimal adherence and recent risky alcohol use and/or stimulant misuse. Qualitative and quantitative data will be collected concerning acceptability, usability and perceived efficacy of components of CARE; Procedures and logistics will be evaluated, and modified, if necessary. Third, CARE will be pilot-tested in a twelve-week randomized controlled trial in which the control arm only involves phone-based counseling focusing first on adherence and then on abstinence. Retention of effects will be examined during a twelve-week follow-up period. CARE has the potential to be among the first interventions that delivers both reinforcement and counseling remotely, that improves outcomes among substance users without providing opioid substitution or other extremely intensive interventions, and that utilizes a cognitive-behavioral approach targeting both non-adherence and substance abuse. Because CARE is delivered by a therapist who is off-site from the patient's clinic, CARE can be effectively delivered from any distance and is a scalable treatment for patients in whom medication adherence is crucial.

描述（由申请人提供）：使用药物或酒精但未充分坚持抗逆转录病毒药物治疗的患者结局欠佳，但缺乏有效的干预措施。在这项R34申请中，我们寻求开发和试点一项通过电话提供并由信息技术支持的干预计划，该计划将药物依从性的应急管理与抗逆转录病毒治疗依从性和滥用物质戒断的认知行为方法相结合。该干预措施CARE（集中式非现场AdhesRence增强计划）建立在已发表的研究结果的基础上，即在接受现金加固以打开MEMS盖瓶按时服用处方药的患者中，依从性得到了有力改善，病毒载量显著降低。CARE涉及将具有真实的操作的开瓶数据从SimPill瓶传输到网站系统，该网站系统向患者生成消息，指示如果在指定的时间窗口内服用药物或如果错过药物则放弃所获得的现金加固量。加强服药将有线到借记卡，病人将收到付款。这种药物服用的偶然强化将与通过电话进行的12次认知行为治疗（CBT）相结合，该网站也将从患者和治疗师协商的选择菜单中生成与CBT相关的短信，提醒和日程安排信息。CARE的发展将分三个阶段进行，每个阶段都对干预措施进行修订。首先，将开发网络系统和治疗手册。第二，将在10名依从性不佳且近期有风险饮酒和/或滥用兴奋剂的患者中进行为期12周的CARE预试验。将收集有关CARE组件的可接受性、可用性和感知功效的定性和定量数据;将评估程序和后勤，并在必要时进行修改。第三，CARE将在一项为期12周的随机对照试验中进行试点测试，其中对照组仅涉及基于电话的咨询，首先关注依从性，然后关注禁欲。将在12周随访期间检查效应的保留。CARE有可能成为第一批远程提供强化和咨询的干预措施之一，在不提供阿片类药物替代或其他非常密集的干预措施的情况下改善药物使用者的结果，并利用针对不依从和药物滥用的认知行为方法。由于CARE是由远离患者诊所的治疗师提供的，因此CARE可以从任何距离有效地提供，并且对于药物依从性至关重要的患者来说是一种可扩展的治疗。

项目成果

A Remotely-Delivered CBT and Contingency Management Therapy for Substance Using People with HIV.

• DOI: 10.1007/s10461-014-0990-x
• 发表时间: 2015-06
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Moore, Brent A.;Rosen, Marc I.;Wang, Yan;Shen, Jie;Ablondi, Karen;Sullivan, Anna;Guerrero, Mario;Siqueiros, Lisa;Daar, Eric S.;Liu, Honghu
• 通讯作者: Liu, Honghu