Comparing the effectiveness of two alcohol+adherence interventions for HIV+ youth

描述(由申请人提供)：艾滋病毒携带者饮酒会加剧健康问题，并加速艾滋病毒疾病的发展。抗逆转录病毒疗法(ART)是艾滋病毒携带者最重要的单一治疗方法。然而，在青少年和感染艾滋病毒的年轻人(以下称为青年)中，坚持抗逆转录病毒治疗的效果并不理想，这是艾滋病毒感染率增长最快的年龄段，也是从事酒精等危险行为风险最大的年龄段。这项拟议的研究将比较基于家庭和基于临床的“健康选择”的有效性，这是一种简短的、为期4个疗程的干预措施，使用动机增强疗法(MET)来解决青少年艾滋病毒携带者(YLH)的酒精使用、用药依从性和健康结果，采用重复措施设计。与以前的试验不同，“健康选择”将在“真实世界”的临床环境中进行测试，并由社区卫生工作者(CHW)提供，他们已经是艾滋病毒护理团队的成员。研究人群将包括年龄在16岁到24岁之间的YLH，他们是5个ATN站点的当前患者。现场工作人员将通过诊所或电话招募潜在参与者。青少年将被随机接受健康选择，在两种情况下，由相同的CHW提供4个疗程的MET，无论是基于诊所还是基于家庭。在基线、4个月(干预后立即)、7个月(干预后3个月)和13个月(干预后9个月)测量结果。生物措施的数据收集将通过医疗记录提取进行，自我报告措施将在每个地点的iPad上使用基于网络的简短CASI(计算机管理的自我访谈)调查进行。所有干预过程将被录音，用于MITI保真度编码，调查人员将在积极干预阶段为当地主管提供支持。我们将在试验结束时与社区卫生工作者、主管和组织领导人进行定性访谈，以获得有关执行障碍和促进者的关键信息。因此，拟议的试验将允许我们使用类型1有效性-实施混合设计来试验在现实世界青年护理环境中实施MI的可持续模式，以实现以下目标：1)检查由社区卫生组织在现实世界青少年艾滋病毒护理环境中提供的有效行为干预的有效性、成本效益和可扩展性；2)收集关于谁在什么情况下做出反应的信息；以及3)增加我们对未来实施的障碍和促进者的理解。

DESCRIPTION (provided by applicant): Alcohol use among persons with HIV exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) is the single most important treatment for people living with HIV. However, ART adherence is suboptimal among adolescents and young adults living with HIV (hereafter called "youth"), the age group with the fastest growing rates of HIV infection, and great risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical setting and be delivered by community health workers (CHW), who are already members of the HIV care team. The study population will consist of YLH, ages 16 to 24, who are current patients at 5 ATN sites. Site staff will recruit potential participants in clinic or by telephone. Youth will be randomized to receive Healthy Choices, 4-sessions of MET for YLH, either clinic-based or home-based delivered by the same CHW in both conditions. Outcomes are measured at baseline, 4 months (immediately post-intervention), 7 months (3 months post-intervention) and 13 months (9 months post-intervention). Data collection for biological measures will be conducted through medical record extraction, and self-reported measures will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on an iPad at each site. All intervention sessions will be audio-recorded for MITI fidelity coding, and investigators will support local supervisors during the active intervention phase. We will conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of the trial to obtain critical information about barriers and facilitators of implementation. Thus, the proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to pilot a sustainable model of MI implementation in real-world youth care settings towards the goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care settings; 2) gathering information about who responds under what contexts; and 3) increasing our understanding of the barriers and facilitators for future implementation.