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

使用生态瞬时评估来定义酒精对艾滋病毒结果的影响

• 批准号: 8822183
• 负责人: ENBAL SHACHAM
• 金额: $ 17.45万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-15 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8822183
• 关键词: AIDS/HIV problem; Adherence; Adult; Alcohol consumption; Alcohols; Behavioral; Behavioral Sciences; CD4 Lymphocyte Count; Caring; Cellular Phone; Clinic; Consumption; Counseling; Cross-Sectional Studies; Data; Development; Dimensions; Disease Progression; Drug usage; Ecological momentary assessment; Effectiveness; Epidemiology; Future; Goals; HIV; Health; Heavy Drinking; High Prevalence; Illicit Drugs; Incidence; Individual; Intervention; Knowledge; Length; Life; Life Expectancy; Link; Location; Measurement; Measures; Methods; Moods; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Process; Reporting; Research; Research Design; Risk; Science; Speed; Survey Methodology; Technology; Testing; Time; Universities; Variant; Viral; Viral Load result; Washington; addiction; antiretroviral therapy; base; design; diaries; drinking; effective intervention; health disparity; improved; liver function; medication compliance; multidisciplinary; prevent; psychological distress; reduced alcohol use; sex; therapy adherence; therapy development; tool; transmission process; user centered design

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.

描述(申请人提供)：艾滋病毒发病率10年来没有下降，预期寿命继续落后于未感染艾滋病毒的人，尽管艾滋病毒护理取得了巨大进步，包括在联合抗逆转录病毒疗法(CART)的有效性和可获得性方面取得了重大改进。坚持用药是防止艾滋病毒传播和进展的关键，但在美国，只有28%的艾滋病毒/艾滋病患者(PLWHA)常规使用所需药物。虽然有许多因素与较低的服药依从性有关，但最重要的障碍之一是酒精使用。几项研究表明，饮酒不仅会降低服药依从性，还会通过无保护和计划外的性行为以及非法药物使用增加艾滋病毒的传播风险。在如此高的流行率下，减少饮酒以增加服药依从性对于降低艾滋病毒的传播和进展至关重要。之前的研究缺乏关于个人随着时间的推移在一天内和一天之间饮酒的细节。如果没有这些消费模式和购物车依从性，我们就酒精使用及其对依从性和病毒学结果的影响向患者提供有效咨询的能力是有限的。我们的总体目标是更好地了解对PLWHA有害的日内和日间酒精使用模式，以便更好地为未来减少酒精使用和增加用药依从性的干预措施提供信息。日常日记和生态瞬间评估(EMA)研究提供了一个独特的机会，在利用自然条件和最大限度地减少回忆偏差的同时，实时检查行为参与及其预测因素和结果。这项研究旨在确定模式的关键细节 使用(酒精的类型、服务的大小、服务的数量、一天的时间、使用的持续时间和消费的地点)，这可能会加强未来旨在减少酒精使用的干预措施的设计和有效性，进而通过改善购物车的依从性来减缓艾滋病毒的进展和降低艾滋病毒的传播风险。酒精消耗量、情绪和购物车忠诚度的日常测量之前没有联系过。随着智能手机用户人数的迅速增长，我们认为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，特别是与日常服药依从性相关的模式，并准确定位有害的酒精使用模式，这将有助于为旨在减少酒精使用、从而减少传播率和减缓艾滋病毒进展的更有效的现实世界干预措施的开发提供信息。具体地说，我们的研究旨在1)收集详细的饮酒模式，其依据是：开始饮酒的时间、饮酒时间、饮酒数量、酒精类型和饮酒地点，以及2)详细饮酒对PLWHA每日用药依从性的影响(通过购物车依从性、HIV病毒载量、CD4细胞计数、肝功能来衡量)。我们假设，某些饮酒模式通过对购物车依附模式的影响，成为PLHWA中不良健康结果的决定因素。

项目成果

Testing the Feasibility of Using Ecological Momentary Assessment to Collect Real-Time Behavior and Mood to Predict Technology-Measured HIV Medication Adherence.

测试使用生态瞬时评估收集实时行为和情绪来预测技术测量的 HIV 药物依从性的可行性。

• DOI: 10.1007/s10461-018-2378-9
• 发表时间: 2019
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Shacham,Enbal;Lew,Daphne;Xiao,Ting;López,Julia;Trull,Timothy;Schootman,Mario;Presti,Rachel
• 通讯作者: Presti,Rachel