Improving HIV and Alcohol-Related Outcomes among HIV+ Persons in Clinic Settings

改善诊所环境中艾滋病毒感染者的艾滋病毒和酒精相关结果

• 批准号: 9059546
• 负责人: JEFFREY T PARSONS
• 金额: $ 67.96万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-20 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9059546
• 关键词: AIDS/HIV problem; Address; Adherence; Affect; Alcohol abuse; Alcohol consumption; Alcohols; Area; Behavior Therapy; Behavioral; CD4 Lymphocyte Count; Caring; Chronic; Clinic; Clinical; Clinical effectiveness; Cognitive; Cohort Analysis; Collaborations; Comorbidity; Complex; Comprehensive Health Care; Computerized Medical Record; Data; Data Analyses; Dependence; Development; Diagnostic; Disease; Disease Progression; Drug resistance; Effectiveness; Effectiveness of Interventions; Enrollment; Environment; Ethnic Origin; Exclusion Criteria; Gender; Goals; HIV; HIV Seropositivity; Health; Health Benefit; Health Personnel; Heavy Drinking; Hospitals; Immunologics; Individual; Intervention; Intervention Studies; Life; Liver; Long-Term Effects; Longevity; Medical; Mental Health; Morbidity - disease rate; Natural History; New York City; Outcome; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Phase; Provider; Public Health; Race; Randomized Controlled Trials; Research; Sampling; Science; Services; System; Testing; Text; Viral; Viral Load result; Viral hepatitis; Woman; Work; age difference; antiretroviral therapy; base; clinical practice; co-infection; cohort; comparative effectiveness; comparison group; cost effective; cost effectiveness; design; drinking; effectiveness research; effectiveness trial; efficacy trial; ethnic diversity; health care service utilization; improved; inclusion criteria; medical appointment; medication compliance; meetings; men; mortality; motivational enhancement therapy; portability; pragmatic trial; programs; prospective; racial and ethnic; racial diversity; reduced alcohol use; resistant strain; sexual HIV transmission; skills training; socioeconomics; theories; therapy adherence; treatment as usual; uptake

DESCRIPTION (provided by applicant): Alcohol consumption at harmful or hazardous levels among HIV-positive (HIV+) persons exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) has been the single most important treatment for people living with HIV to optimize viral suppression and slow disease progression. Adherence to ART has considerable public health implications, particularly given that optimal adherence decreases morbidity and mortality, decreases the potential for the development of drug resistant strains of HIV, and reduces HIV infectiousness. Project PLUS (Positive Living through Understanding and Support) was the first (and to our knowledge only) theory-based behavioral intervention, which integrates motivational interviewing and cognitive-behavioral skills training, to demonstrate significant improvements in viral load, CD4 cell count, and self-reported adherence among a racially and ethnically diverse sample of HIV+ women and men enrolled in a randomized controlled trial, and the first intervention for hazardous drinkers to demonstrate any significant effects. A clinic-based replication is the crucial next step in studying the intervention's effectiveness in the real world when delivered by HIV clinic providers to their patients. In collaboration with medical providers at the Center for Comprehensive Care (CCC) at St. Luke's-Roosevelt Hospital Center, the largest provider of HIV medical care in the New York City area with over 5000 active HIV+ patients, our goals are to better understand alcohol-related outcomes among HIV+ persons over the lifespan and to conduct a multisite comparative effectiveness trial with three intensities of treatment-the PLUS intervention, an enhanced treatment as usual (eTAU) condition, and treatment as usual (TAU) condition-to test the clinical and cost-effectiveness of the PLUS intervention in reducing alcohol use and improving ART adherence, viral load, and CD4 counts among HIV+ hazardous drinkers. We will achieve our goals through four specific aims: 1) adapt the PLUS intervention for delivery in HIV clinic settings by mental health providers, and incorporate booster sessions to sustain longer-term effects; 2) test the effectiveness of the PLUS intervention relative to eTAU and TAU alone for HIV+ hazardous drinkers when delivered in a consortium of HIV clinics in New York City; 3) assess the cost-effectiveness of PLUS to an eTAU condition and TAU alone as estimated over 5- and 10-year windows; and 4) analyze retrospective cohort data and prospective natural history data via CCC's Electronic Medical Records. Working together with CCC experts will help to address practical problems at the frontline of medical service provision to pave the way for a comprehensive program in reducing alcohol use and improving ART adherence and health outcomes among HIV+ persons. Our project has the potential to exert a sustained and powerful impact not only on the effectiveness of ART interventions for HIV+ persons with problematic drinking, but also on the effective use of EMR data to examine the relationship among alcohol and HIV-related outcomes in a large urban and diverse cohort of HIV+ clinic patients.

描述（由申请人提供）：HIV阳性（HIV+）人群中有害或危险水平的酒精消费会加剧健康问题并加速HIV疾病进展。抗逆转录病毒疗法（ART）一直是艾滋病毒感染者最重要的治疗方法，以优化病毒抑制和减缓疾病进展。坚持抗逆转录病毒疗法具有相当大的公共卫生影响，特别是考虑到最佳坚持可降低发病率和死亡率，降低艾滋病毒耐药株发展的可能性，并降低艾滋病毒的传染性。项目PLUS（通过理解和支持积极生活）是第一个（仅据我们所知）基于理论的行为干预，它整合了动机访谈和认知行为技能培训，以证明在随机对照试验中招募的种族和民族多样性HIV+女性和男性样本中病毒载量，CD 4细胞计数和自我报告的依从性方面的显着改善，也是对危险饮酒者的第一次干预，以证明任何显着的影响。基于诊所的复制是研究干预措施在真实的世界中的有效性的关键下一步，当艾滋病毒诊所提供者向他们的病人提供干预措施时。与圣卢克-罗斯福医院中心综合护理中心的医疗提供者合作，该中心是纽约市地区最大的艾滋病毒医疗服务提供者，有5000多名活跃的艾滋病毒阳性患者，我们的目标是更好地了解艾滋病毒阳性者在生命周期中与酒精相关的结果，并进行一项多地点的比较有效性试验，采用三种治疗强度-PLUS干预、增强型常规治疗（eTAU）条件和常规治疗（TAU）条件--旨在测试PLUS干预在减少饮酒和改善HIV+危险饮酒者的ART依从性、病毒载量和CD 4计数方面的临床和成本效益。我们将通过四个具体目标实现我们的目标：1）调整PLUS干预措施，使其适用于心理健康提供者在艾滋病毒诊所环境中提供的服务，并纳入强化治疗以维持长期效果; 2）在纽约市的艾滋病毒诊所联盟中提供时，测试PLUS干预措施相对于eTAU和TAU单独用于艾滋病毒+危险饮酒者的有效性; 3）评估PLUS对eTAU疾病和单独TAU的成本效益，估计超过5年和10年的时间窗; 4）通过CCC的电子病历分析回顾性队列数据和前瞻性自然病史数据。与CCC专家合作将有助于解决医疗服务提供前线的实际问题，为减少酒精使用、改善艾滋病毒+患者抗逆转录病毒治疗依从性和健康结果的综合计划铺平道路。我们的项目有可能不仅对有饮酒问题的艾滋病毒+患者的ART干预措施的有效性产生持续而强大的影响，而且对有效利用电子病历数据来检查酒精与艾滋病毒相关结果之间的关系产生持续而强大的影响。城市和多元化的艾滋病毒+诊所患者队列。