Integration of Evidence-based Alcohol Interventions into HIV Care

将循证酒精干预措施纳入艾滋病毒护理

• 批准号: 8720633
• 负责人: Michael S. Saag
• 金额: $ 46.87万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-10 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8720633
• 关键词: Accident and Emergency department; Address; Adherence; Adoption; Alcohol abuse; Alcohol consumption; Alcohols; Caring; Case Management; Clinic; Clinical; Clinical Trials; Communities; Computers; Disease Progression; E-learning; Effectiveness; FDA approved; Funding; HIV; Health; Individual; Intervention; Knowledge; Life; Long-Term Care; Longevity; Mainstreaming; Maintenance; Medical; Mental Depression; Meta-Analysis; Modeling; Morbidity - disease rate; Outcome; Participant; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Play; Primary Health Care; Principal Investigator; Provider; Quality of life; Randomized; Reporting; Research; Role; Services; Site; Stream; System; Training; Translations; Treatment Efficacy; Visit; alcohol abuse therapy; alcohol intervention; alcohol screening and brief intervention; alcohol services; alcohol use disorder; alcoholism pharmacotherapy; alcoholism therapy; antiretroviral therapy; binge drinking; brief alcohol intervention; brief intervention; clinical care; clinical practice; cohort; comparative effectiveness; compare effectiveness; computerized; cost; cost effectiveness; drinking; effectiveness trial; evidence base; follow-up; hazardous drinking; improved; interest; medical specialties; mortality; outreach; point of care; reduced alcohol use; response; screening; standard care; standard of care; university student; uptake

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.

描述（由申请人提供）：艾滋病毒感染的个体中普遍存在危险饮酒，并且与抗逆转录病毒疗法的摄取，依从性和病毒学抑制有关。不幸的是，传统酒精治疗服务中的患者参与和保留率很差。筛查，短暂的酒精干预和转诊（SBIRT）已显示可有效减少危险的饮酒并改善初级保健和急诊室环境中与健康相关的结果。除SBIRT外，还有几种FDA批准的药物治疗剂，在减少饮酒量方面具有功效。通过HIV诊所的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绝佳的机会。利用综合临床系统（CNIC）的CFAR网络，该网络由8个临床组组成，在美国各地由超过20,000个HIV感染的人组成，我们将研究计算机提供的短暂干预措施以及HIV提供者药物治疗培训的有效性，以开出在HIV临床治疗中提供的酒精治疗方法。所有CNICS患者都将被筛查危险或暴饮暴食，并在第一次访问时将对具有正面筛查的个人进行计算机化的简短干预（CBI）。在第二次访问（大约3个月后），继续筛选正阳性的参与者将获得另一届CBI会议，或者将提供CBI和酒精药品（CBL+APT）。所有参与者将额外遵循6个月的时间，以确定降低酒精和与HIV相关的结果。预计CBL+APT将比单独使用CBI更有效，而仅CBI将比降低危险饮酒和改善与HIV相关的结果更有效。此外，我们将检查与患者相关的护理中参与度和保留率的预测指标，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，以确定在这种情况下这些干预措施的影响。