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

减少初级保健中艾滋病毒感染男性酗酒的行为干预措施。

• 批准号: 8838920
• 负责人: Christopher W. Kahler
• 金额: $ 43.32万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838920
• 关键词: Address; Alcohol consumption; Alcohol dependence; Alcohols; Anus; Behavior Therapy; Behavioral; CD4 Lymphocyte Count; Caring; Cellular Phone; Clinic; Collaborations; Counseling; Data; Disease; Effectiveness; Feedback; Functional disorder; HIV; HIV Infections; Heavy Drinking; Infection; Inflammation; Insulin Resistance; Intervention; Lead; Life; Liver Function Tests; Liver diseases; Location; Metabolic; Monitor; Motivation; Neurocognitive; Outcome; Oxidative Stress; Participant; Patients; Phase; Population; Primary Health Care; Publishing; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recruitment Activity; Relative (related person); Research; Risk; Sampling; Serum; System; Technology; Telemedicine; Testing; Text; Time; Viral; Voice; Work; alcohol intervention; alcohol use disorder; antiretroviral therapy; base; biobehavior; brief advice; brief motivational intervention; clinical care; cognitive function; cost; cost effectiveness; design; drinking; follow-up; hazardous drinking; improved; indexing; individualized medicine; liver function; men; men who have sex with men; problem drinker; public health priorities; response; secondary outcome; sex; sex risk; sexual risk taking; therapy adherence; treatment as usual; virology

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.

项目摘要 艾滋病毒感染患者的大量饮酒会导致低抗逆转录病毒疗法的依从性和病毒学性差 控制，更大的性风险服用，增加肝病的风险以及认知功能降低。所以， 饮酒的减少可能对感染的HIV感染患者产生特别积极和普遍的影响。男人 与男性发生性关系（MSM）继续代表大多数新的艾滋病毒感染和HIV感染的MSM 危险饮酒率高达33％。因此，开发和测试干预措施以减少 大量的HIV感染的MSM饮酒是很高的公共卫生优先事项。酒精相对较少 干预措施测试了关注MSM的干预措施，并且只有两种针对HIV感染的MSM饮酒。虽然 最近的研究表明，行为干预措施可以减少感染HIV的患者的大量饮酒，很多 关于行为干预及其独特和其独特和其独特方法的功效的功效仍然未知 综合效果。本研究的目的是进行全面的2 x 2 x 2阶乘随机进行 对照试验，从2家城市HIV初级保健诊所招募了224个MSM样本（一个 东北，南部）。第一个研究因素将比较简短建议（BA）与动机 干预（MI）包含详细的个性化规范和特定于HIV的反馈。第二个因素 比较交互式文本消息（ITM）干预与无文本消息传递。最终因素比较 低强度和持续时间的干预（在1个月内进行了两次会议）进行扩展干预（EI）5 9个月内的会议。 BA和MI将由中心地点的一组核心干预者提供 使用启用网络摄像头的远程医疗系统，该系统可以促进大规模实现。设计 将允许我们检验MI与BA相比的假设，ITM与ITM相比，而EI与NO相比 EI，将导致消耗的酒精饮料数量和重量的数量大大减少 在6个月和12个月的随访中饮酒天。次要结果包括参与未受保护的肛门 性交，艺术依从性和病毒抑制，CD4细胞计数，肝功能测试和神经认知 功能。我们还将检验以下假设：MI，ITM和EI对饮酒的影响 酒精使用障碍状况和愿意改变饮酒，使这些干预措施相对 在患有当前疾病和准备较低的患者的患者中，更有效。该研究将提供至关重要的 关于单独或合并哪种干预方法的证据可能是最有效的 大规模实施在艾滋病毒护理环境中。