Improving HIV and Alcohol-Related Outcomes among HIV+ Persons in Clinic Settings

描述（由申请人提供）： HIV 阳性 (HIV ) 患者饮酒达到有害或危险水平会加剧健康问题并加速 HIV 疾病的进展。抗逆转录病毒治疗 (ART) 一直是艾滋病毒感染者最重要的治疗方法，可以优化病毒抑制并减缓疾病进展。坚持抗逆转录病毒治疗对公共卫生具有相当大的影响，特别是考虑到最佳的坚持可以降低发病率和死亡率，降低艾滋病毒耐药株发展的可能性，并降低艾滋病毒的传染性。 PLUS项目（通过理解和支持实现积极生活）是第一个（据我们所知）基于理论的行为干预，它整合了动机访谈和认知行为技能培训，在随机对照试验中证明了病毒载量、CD4细胞计数和自我报告的依从性在不同种族和民族的艾滋病毒女性和男性样本中的显着改善，也是第一个针对危险饮酒者的干预措施，显示出任何显着效果。基于临床的复制是研究艾滋病毒诊所提供者向患者提供的干预措施在现实世界中的有效性的关键下一步。圣卢克-罗斯福医院中心综合护理中心 (CCC) 是纽约地区最大的艾滋病毒医疗服务提供者，拥有 5000 多名活跃的艾滋病毒患者，我们与圣卢克罗斯福医院中心的综合护理中心 (CCC) 的医疗提供者合作，我们的目标是更好地了解艾滋病毒感染者一生中与酒精相关的结果，并通过三种治疗强度（PLUS 干预、增强照常治疗 (eTAU) 条件和照常治疗 (TAU) 条件）进行多中心比较有效性试验，以进行测试PLUS 干预措施在减少 HIV 危险饮酒者的饮酒和改善 ART 依从性、病毒载量和 CD4 计数方面的临床和成本效益。我们将通过四个具体目标来实现我们的目标：1）调整 PLUS 干预措施，以由心理健康服务提供者在 HIV 诊所环境中提供，并纳入加强课程以维持长期效果； 2) 测试在纽约市 HIV 诊所联盟中实施的 PLUS 干预措施相对于 eTAU 和单独 TAU 对于 HIV 危险饮酒者的有效性； 3) 评估 PLUS 对 eTAU 条件和单独 TAU 的成本效益（按 5 年和 10 年窗口估计）； 4) 通过 CCC 的电子病历分析回顾性队列数据和前瞻性自然史数据。与 CCC 专家合作将有助于解决医疗服务提供第一线的实际问题，为减少艾滋病毒感染者饮酒、提高抗逆转录病毒治疗依从性和健康结果的综合计划铺平道路。我们的项目有可能产生持续而强大的影响，不仅对有饮酒问题的艾滋病毒感染者的抗逆转录病毒治疗的有效性产生持续而强大的影响，而且还对有效利用电子病历数据来检查大型城市和不同的艾滋病毒诊所患者群体中酒精和艾滋病毒相关结果之间的关系产生持续而强大的影响。

DESCRIPTION (provided by applicant): Alcohol consumption at harmful or hazardous levels among HIV-positive (HIV+) persons exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) has been the single most important treatment for people living with HIV to optimize viral suppression and slow disease progression. Adherence to ART has considerable public health implications, particularly given that optimal adherence decreases morbidity and mortality, decreases the potential for the development of drug resistant strains of HIV, and reduces HIV infectiousness. Project PLUS (Positive Living through Understanding and Support) was the first (and to our knowledge only) theory-based behavioral intervention, which integrates motivational interviewing and cognitive-behavioral skills training, to demonstrate significant improvements in viral load, CD4 cell count, and self-reported adherence among a racially and ethnically diverse sample of HIV+ women and men enrolled in a randomized controlled trial, and the first intervention for hazardous drinkers to demonstrate any significant effects. A clinic-based replication is the crucial next step in studying the intervention's effectiveness in the real world when delivered by HIV clinic providers to their patients. In collaboration with medical providers at the Center for Comprehensive Care (CCC) at St. Luke's-Roosevelt Hospital Center, the largest provider of HIV medical care in the New York City area with over 5000 active HIV+ patients, our goals are to better understand alcohol-related outcomes among HIV+ persons over the lifespan and to conduct a multisite comparative effectiveness trial with three intensities of treatment-the PLUS intervention, an enhanced treatment as usual (eTAU) condition, and treatment as usual (TAU) condition-to test the clinical and cost-effectiveness of the PLUS intervention in reducing alcohol use and improving ART adherence, viral load, and CD4 counts among HIV+ hazardous drinkers. We will achieve our goals through four specific aims: 1) adapt the PLUS intervention for delivery in HIV clinic settings by mental health providers, and incorporate booster sessions to sustain longer-term effects; 2) test the effectiveness of the PLUS intervention relative to eTAU and TAU alone for HIV+ hazardous drinkers when delivered in a consortium of HIV clinics in New York City; 3) assess the cost-effectiveness of PLUS to an eTAU condition and TAU alone as estimated over 5- and 10-year windows; and 4) analyze retrospective cohort data and prospective natural history data via CCC's Electronic Medical Records. Working together with CCC experts will help to address practical problems at the frontline of medical service provision to pave the way for a comprehensive program in reducing alcohol use and improving ART adherence and health outcomes among HIV+ persons. Our project has the potential to exert a sustained and powerful impact not only on the effectiveness of ART interventions for HIV+ persons with problematic drinking, but also on the effective use of EMR data to examine the relationship among alcohol and HIV-related outcomes in a large urban and diverse cohort of HIV+ clinic patients.