Using Ecologic Momentary Assessment to Define Alcohol's Impact on HIV Outcomes

描述（由申请人提供）：尽管艾滋病毒护理取得了巨大进步，包括联合抗逆转录病毒疗法（cART）的有效性和可用性的重大改善，但艾滋病毒的发病率在10年内没有下降，预期寿命继续落后于未感染者。药物依从性是预防艾滋病毒传播和进展的关键，但在美国，只有28%的艾滋病毒/艾滋病（PLWHA）感染者定期使用所需的药物。虽然有许多因素与较低的药物依从性有关，但最重要的障碍之一是饮酒。几项研究表明，饮酒不仅降低了药物依从性，而且增加了无保护和无计划的性行为以及非法药物使用造成的艾滋病毒传播风险。在如此高的流行率下，减少饮酒以提高药物依从性对于降低艾滋病毒传播和进展至关重要。以前的研究缺乏关于一个人一天之内和一天之间饮酒的细节。如果没有这些消费模式和cART依从性，我们就无法有效地向患者提供有关酒精使用及其对依从性和病毒学结果的影响的咨询。我们的总体目标是更好地了解对艾滋病毒/艾滋病感染者有害的日内和日间饮酒模式，以便更好地为未来的干预措施提供信息，以减少饮酒和增加药物依从性。每日日记和生态瞬时评估（EMA）研究提供了一个独特的机会，检查在真实的时间行为参与及其预测因素和后果，同时利用自然条件和最大限度地减少回忆偏差。本研究的目的是确定模式的关键细节 使用（酒精类型，服务大小，服务数量，一天中的时间，使用持续时间和消费地点），这可能会加强未来干预措施的设计和有效性，旨在减少酒精使用，从而通过提高cART依从性来减缓HIV进展并降低HIV传播风险。饮酒量、情绪和cART依从性的日常测量以前没有联系。随着智能手机拥有者人口的快速增长，我们建议这项技术提供了一个独特的机会，可以更好地了解详细的酒精使用模式的关键方面，特别是与日常药物依从性相关的方面，并查明有害的酒精使用模式，这将有助于为更有效的干预措施提供信息。具体来说，我们的研究旨在1）收集酒精使用的详细模式，基于：一天中开始消费的时间，消费时间，消费的饮料数量，酒精类型和消费发生的位置，2）描述详细的酒精消费对PLWHA每日药物依从性的影响（通过cART依从性，HIV病毒载量，CD 4细胞计数，肝功能测量）。我们假设，某些模式的酒精消费作为PLHWA之间的不良健康结果的决定因素，通过其对cART依从性模式的影响。

DESCRIPTION (provided by applicant): Incidence of HIV has not decreased in 10 years and life expectancy continues to lag behind those who are uninfected despite tremendous advances in HIV care, including major improvements in effectiveness and availability of combination antiretroviral therapies (cART). Medication adherence is key to preventing HIV transmission and progression, yet only 28% of people living with HIV/AIDS (PLWHA) in the U.S. are using required medication routinely. While there are many factors that are associated with lower medication adherence, one of the most important barriers is alcohol use. Several studies have shown that alcohol use not only reduced medication adherence but also increased HIV transmission risk by unprotected and unplanned sex, and illicit drug use. With such high prevalence rates, reducing alcohol use to increase medication adherence is critical to lowering HIV transmission and progression. Previous studies lack details about an individual's intra- and inter-day alcohol use over time. Without those patterns of consumption and cART adherence, we are limited in our ability to effectively counsel patients about alcohol use and its effects on adherence and virologic outcomes. Our overall goal is to better understand the intra- and inter-day patterns of alcohol use that are detrimental to PLWHA in order to better inform future interventions to reduce alcohol use and increase medication adherence. Daily diary and ecological momentary assessment (EMA) studies provide a unique opportunity to examine in real time behavioral engagement and its predictors and consequences while utilizing naturalistic conditions and minimizing recall bias. This study aims to identify the critical details on patterns of use (type of alcohol, size of serving, number of servings, time of day, duration of use, and location consumed) that may enhance the design and effectiveness of future interventions aimed at reducing alcohol use and in turn, slowing HIV progression and reducing HIV transmission risk by improving cART adherence. The daily measurement of alcohol consumption, mood, and cART adherence has not been linked previously. With the rapidly growing population of smart phone owners, we propose that this technology offers a unique opportunity to better understand crucial aspects of detailed alcohol use patterns particularly related to daily medication adherence and pinpoint detrimental alcohol use patterns that will help inform intervention development for more effective real-world interventions aimed at reducing alcohol use and thereby transmission rates and slowing HIV progression. Specifically, our study aims to 1) collect detailed patterns of alcohol use based on: time of day when consumption begins, length of consumption, number of drinks consumed, type of alcohol, and location where consumption occurs, and 2) characterize the effect of detailed alcohol consumption on daily medication adherence among PLWHA (as measured by cART adherence, HIV viral load, CD4 cell count, liver functions). We hypothesize that certain patterns of alcohol consumption serve as determinants of poor health outcomes among PLHWA, through their impact on cART adherence patterns.