Integration of Evidence-based Alcohol Interventions into HIV Care

描述（由申请人提供）：危险饮酒在艾滋病毒感染者中普遍存在，并与抗逆转录病毒治疗的吸收、依从性和病毒学抑制下降有关。不幸的是，在传统的酒精治疗服务中，患者的参与和保留度很差。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的健康相关结果方面是有效的。除了SBIRT，还有几种fda批准的药物疗法在减少酒精消费方面表现出疗效。在艾滋病毒诊所通过SBIRT在护理点提供干预，为短期酒精干预和酒精药物治疗的整合提供了极好的机会。利用CFAR综合临床系统网络（CNICS），一个由美国8个临床队列和超过20,000名HIV感染者组成的国家网络，我们将检查计算机提供的简短干预以及HIV提供者药物治疗培训的有效性，以在HIV临床护理环境中提供酒精治疗药物。所有CNICS患者将接受危险或酗酒筛查，筛查阳性的个体将在首次就诊时接受计算机化简短干预（CBI）。在第二次访问时（大约3个月后），继续筛查阳性的参与者将接受另一次CBI治疗，或给予CBI和酒精药物疗法（CBl+APT）。所有参与者将被额外随访6个月，以确定酒精减少和艾滋病毒相关的结果。预计CBl+APT将比单独使用CBI更有效，而单独使用CBI在减少危险饮酒和改善艾滋病毒相关结果方面将比标准护理更有效。此外，我们将检查患者参与和保留护理的相关预测因素，并确定在HIV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种情况下的影响。

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.