Reducing Hazardous Alcohol Use & HIV Viral Load:An RCT in ART Clinics in Vietnam

描述(由申请人提供)：项目摘要/摘要艾滋病毒感染者的危险饮酒与严重的健康后果有关，包括减少对抗逆转录病毒治疗(ART)的坚持和减少病毒学抑制。在艾滋病毒保健环境中，危险饮酒对艾滋病毒感染者的严重后果往往被忽视。在许多资源匮乏的环境中，饮酒被广泛接受，对潜在风险的了解有限。在越南，社会鼓励饮酒，危险饮酒无处不在；超过20%的抗逆转录病毒治疗患者是危险饮酒者。注射吸毒者(IDU)占越南艾滋病毒感染者的很大比例，许多人同时感染了乙肝病毒和丙型肝炎病毒。在与乙肝病毒和丙型肝炎病毒混合感染的艾滋病毒感染者中，危险饮酒与肝病恶化密切相关，这进一步突出了在这方面迫切需要采取有效的减少酒精干预措施。 我们提出了一项三臂随机对照试验，以评估两种循证干预措施在越南危险和大量饮酒的艾滋病毒感染ART诊所患者中减少酒精使用的比较有效性和成本效益。动机增强疗法(MET)是一种4节干预措施，旨在通过内部动机的改变产生变化，而认知行为疗法(CBT)是一种更密集的12节干预措施，重点是培养管理酒精诱因的技能。使用创新的优势等效性设计，我们将评估这两种干预措施是否比仅进行评估的对照产生更好的结果，同时比较这两种干预措施对患者重要结局和成本的影响。我们的主要成果将包括戒酒、抑制艾滋病毒病毒和递增的成本效益，所有这些都是在每次干预开始后一年内衡量的。

DESCRIPTION (provided by applicant): Project Summary/Abstract Hazardous drinking among HIV-infected individuals is associated with serious health outcomes, including decreased adherence to antiretroviral therapy (ART) and decreased virologic suppression. The serious consequences of hazardous alcohol use for HIV infected individuals are often neglected in HIV health care settings. In many low resource settings, alcohol use is widely accepted and knowledge of potential risks is limited. In Vietnam, alcohol use is socially encouraged and hazardous drinking pervasive; over 20% of ART patients are hazardous drinkers. Injection drug users (IDU) comprise a large proportion of those infected with HIV in Vietnam and many are co-infected with HBV and HCV. Hazardous drinking is significantly associated with increased progression of liver disease among HIV-infected individuals co-infected with HBV and HCV, further underscoring the urgent need for effective alcohol reduction interventions in this context. We propose a three-arm randomized controlled trial to evaluate the comparative effectiveness and cost-effectiveness of two evidence-based interventions to reduce alcohol use among hazardous and heavy drinking HIV-infected ART clinic patients in Vietnam. Motivational Enhancement Therapy (MET) is a 4-session intervention that seeks to produce change through internally motivated change, while Cognitive Behavioral Therapy (CBT) is a more intensive, 12-session intervention that focuses on developing skills to manage triggers for alcohol. Using an innovative superiority-equivalency design, we will assess whether these two interventions result in better outcomes than an assessment-only control while simultaneously comparing the interventions against each other in terms of impact on patient-important outcomes and costs. Our primary outcomes will include abstinence from alcohol, HIV viral suppression, and incremental cost-effectiveness, all measured up to one year after starting each intervention.