Integration of Evidence-based Alcohol Interventions into HIV Care

描述(由申请人提供)：危险酒精使用在艾滋病毒感染者中很普遍，并与抗逆转录病毒治疗的接受率、依从性和病毒学抑制程度降低有关。不幸的是，在传统的酒精治疗服务中，患者的参与度和保留率很低。筛查、短暂酒精干预和转诊治疗(SBIRT)已被证明在减少有害酒精使用和改善初级保健和急诊室环境中与健康相关的结果方面有效。除了SBIRT，还有几种FDA批准的药物疗法在减少酒精消耗方面证明了有效性。在艾滋病毒诊所通过SBIRT在护理点提供干预，为整合短暂的酒精干预和酒精药物治疗提供了一个极好的机会。利用CFAR综合临床系统网络(CNICs)，这是一个由全美8个临床队列和20,000多名艾滋病毒感染者组成的全国性网络，我们将检查计算机提供的简短干预以及艾滋病毒提供者药物治疗培训的有效性，以开出在艾滋病毒临床护理环境中提供的酒精治疗药物。所有CNICS患者都将接受危险饮酒或酗酒的筛查，筛查阳性的患者将在第一次就诊时接受计算机化短暂干预(CBI)。在第二次访问中(大约3个月后)，继续筛查呈阳性的参与者将接受另一次CBI治疗，或将接受CBI和酒精药物治疗(CBL+APT)。所有参与者将再接受6个月的跟踪调查，以确定减少饮酒和艾滋病毒相关结果。预计CBL+APT将比单独使用CBI更有效，而在减少危险饮酒和改善艾滋病毒相关结果方面，单独使用CBI将比标准护理更有效。此外，我们将研究与患者相关的参与和保留护理的预测因素，并确定在艾滋病毒临床护理环境中成功整合这些干预措施的障碍。最后，将进行成本效益分析，以确定这些干预措施在这一背景下的影响。

DESCRIPTION (provided by applicant): Hazardous alcohol use is prevalent among HIV infected individuals, and is associated with decreased antiretroviral therapy uptake, adherence, and virologic suppression. Unfortunately, patient engagement and retention in traditional alcohol treatment services is poor. Screening, brief alcohol intervention, and referral to treatment (SBIRT) has been shown to be effective in reducing hazardous alcohol use and improving health- related outcomes in primary care and emergency room settings. In addition to SBIRT, there are several FDA-approved pharmacotherapies with demonstrated efficacy in reducing alcohol consumption. Providing intervention at the point-of-care through SBIRT in HIV clinics offers an excellent opportunity for integration of brief alcohol intervention and alcohol pharmacotherapy. Utilizing the CFAR Network of Integrated Clinical Systems (CNICS), a national network comprised of 8 clinical cohorts and over 20,000 HIV-infected individuals across the US, we will examine the effectiveness of a computer-delivered brief intervention as well as a an HIV provider pharmacotherapy training to prescribe alcohol treatment medications delivered in the HIV clinical care setting. All CNICS patients will be screened for hazardous or binge drinking and individuals with positive screens will be administered the computerized brief intervention (CBI) at their first visit. At the second visit (approximately 3 months later), participants who continue to screen positive will receive either another session of CBI or will be offered CBI and alcohol pharmacotheray (CBl+APT). All participants will be followed for an additional 6 months to determine alcohol reduction and HIV-related outcomes. It is expected that CBl+APT will be more effective than CBI alone, while CBI alone will be more effective than standard of care for reducing hazardous drinking and improving HIV-related outcomes. Further, we will examine patient-related predictors of engagement and retention in care and determine barriers to successful integration of these interventions in the HIV clinical care setting. Finally, cost- effectiveness analyses will be conducted to determine the impact of these interventions in this setting.