Behavioral interventions to reduce heavy drinking in HIV-infected men in primary care.

项目摘要 艾滋病毒感染者酗酒可能导致抗逆转录病毒治疗依从性低和病毒学不良 控制，更大的性风险，增加肝脏疾病的风险和认知功能下降。因此，我们认为， 减少饮酒可能对艾滋病毒感染者产生特别积极和广泛的影响。的男人 与男性发生性关系（MSM）继续占新感染艾滋病毒的大多数， 危险饮酒率高达33%因此，制定和测试干预措施，以减少 在感染艾滋病毒的男男性行为者中大量饮酒是一个非常高的公共卫生优先事项。酒精含量相对较少 目前，已经测试了以男男性行为者为重点的干预措施，只有两项干预措施涉及感染艾滋病毒的男男性行为者的饮酒问题。虽然 最近的研究表明，行为干预可以减少艾滋病毒感染者的大量饮酒， 仍然不知道不同的行为干预方法的有效性及其独特性， 综合效应。本研究的目的是进行一个完全交叉的2 × 2 × 2析因随机 一项对照试验，从2个城市艾滋病初级保健诊所招募了224名MSM（其中一个在 一个在东北，一个在南方）。第一个学习因素将比较简短的建议（BA）与动机 干预（MI），其中包含详细的个性化规范和艾滋病毒的具体反馈。第二个因素 比较了交互式文本消息（ITM）干预与无文本消息干预。最后一个因素比较 低强度和持续时间的干预（1个月内两次）到扩展干预（EI）， 9个月以上的会议。BA和MI将由一组核心干预专家从中心位置提供 使用网络摄像头远程医疗系统，这有助于更大规模的实施。设计 将允许我们检验MI与BA相比、ITM与无ITM相比以及EI与无ITM相比的假设。 EI，将导致消费的酒精饮料数量和重 6个月和12个月随访时的饮酒天数。次要结局包括参与无保护肛门 性交、ART依从性和病毒抑制、CD4细胞计数、肝功能检查和神经认知 功能我们还将检验以下假设：MI、ITM和EI对饮酒的影响将受到以下因素的调节： 酒精使用障碍状态和改变饮酒的准备，这些干预措施将相对 对那些目前有障碍和准备不足的人更有效。这项研究将提供关键的 关于哪种干预方法（单独或组合）可能最有效， 在艾滋病毒护理环境中大规模实施。

PROJECT SUMMARY Heavy drinking in HIV-infected patients can lead to low antiretroviral therapy adherence and poor virologic control, greater sexual risk taking, increased risk of liver disease, and decreased cognitive function. Therefore, reductions in drinking may have particularly positive and widespread effects in HIV-infected patients. Men who have sex with men (MSM) continue to represent the majority of new HIV infections, and HIV-infected MSM have rates of hazardous drinking as high as 33%. Therefore, developing and testing interventions to reduce heavy drinking in HIV-infected MSM is a very high public health priority. There have been relatively few alcohol interventions tested that focus on MSM, and only two have addressed drinking in HIV-infected MSM. Although recent studies indicate that behavioral interventions can reduce heavy drinking in HIV-infected patients, much remains unknown about the efficacy of different approaches to behavioral intervention and their unique and combined effects. The purpose of the present study is to conduct a fully-crossed 2 X 2 X 2 factorial randomized controlled trial with a diverse sample of 224 MSM recruited from 2 urban HIV primary care clinics (one in the Northeast and one in the South). The first study factor will compare brief advice (BA) vs. a motivation intervention (MI) that contains detailed personalized normative and HIV-specific feedback. The second factor compares an interactive text messaging (ITM) intervention vs. no text messaging. The final factor compares intervention of low intensity and duration (two sessions over 1 month) to extended intervention (EI) entailing 5 sessions over 9 months. BA and MI will be delivered by a core set of interventionists from a central location using a webcam-enabled telemedicine system, which can facilitate larger-scale implementation. The design will allow us to test the hypothesis that MI compared to BA, ITM compared to no ITM, and EI compared to no EI, will result in significantly greater reductions in number of alcoholic drinks consumed and number of heavy drinking days at 6- and 12-month follow-ups. Secondary outcomes include engagement in unprotected anal intercourse, ART adherence and viral suppression, CD4 cell count, liver function tests, and neurocognitive function. We also will test the hypothesis that the effects of MI, ITM, and EI on drinking will be moderated by alcohol use disorder status and readiness to change drinking such that these interventions will be relatively more efficacious in those with a current disorder and those with low readiness. The study will provide crucial evidence regarding which intervention approaches, alone or in combination, are likely to be most efficient to implement on a large scale in HIV care settings.