Internet-Based Video-Conferencing to Address Alcohol Use and Pain Among Heavy Drinkers in HIV-Care

项目概要/摘要 慢性疼痛和大量饮酒是艾滋病毒感染者常见的并发症 （PLWH），其中每一个都对日常功能和艾滋病毒相关的结果产生负面影响。此外，委员会认为， 这些共病状况彼此具有显著影响。疼痛是酒精的重要诱因 在重度饮酒者中使用，并与酒精相关的负面后果的经历有关。 在PLWH中，随着时间的推移，中度或更大的疼痛与危险的饮酒有关。同样，问题 饮酒会干扰慢性疼痛患者的疼痛管理努力，并与早期辍学有关 从治疗。临床医生面临着许多挑战，在他们的努力，以解决这些经常共同发生的 条件包括患者改变的动机低，对治疗的依从性差，以及频繁的障碍， 使用药物治疗来充分治疗这两种情况。考虑到慢性疼痛和 大量饮酒的艾滋病毒感染者，其综合影响的日常运作和艾滋病毒的结果，并提供 治疗的局限性，将有相当大的好处，以综合行为的方法来解决 这些共病条件的方式，可以很容易地纳入艾滋病毒护理环境， 患者使用。通过UH 2/UH 3机制，该提案的目标是：1）制定一个 综合行为视频远程保健干预方法，以减少重度 饮酒艾滋病病毒感染者慢性疼痛，并确定其可行性和可接受性（UH 2）和2） 通过随机对照试验（UH 3）获得干预有效性的效应量估计值。这 一项研究首次尝试利用视频远程医疗方法来解决患者的饮酒和疼痛问题 此设置UH 2组件将用于治疗开发和小样本初始测试 开放式试点中的患者。沿着的患者可接受性和可行性证据 已确定结果的变化将提供UH 3组成部分所依据的数据， 通过随机对照试验初步检验干预效果。

PROJECT SUMMARY/ABSTRACT Chronic pain and heavy drinking are common co-occurring conditions among people living with HIV infection (PLWH) each of which have a negative impact on daily functioning and HIV-related outcomes. Moreover, these comorbid conditions have a significant impact on one another. Pain is an important trigger for alcohol use among heavy drinkers and is linked with the experience of negative alcohol-related consequences. Among PLWH, moderate or greater pain has been linked with risky drinking over time. Similarly, problem drinking interferes with pain management efforts among those with chronic pain and is linked to earlier dropout from treatment. Clinicians face a number of challenges in their efforts to address these frequently co-occurring conditions including low patient motivation for change, poor adherence to treatment, and frequent barriers to using pharmacological treatments to adequately treat both conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be readily incorporated into HIV-care settings and easily utilized by patients. Through the UH2/UH3 mechanism the objectives of the proposal are to, 1) develop an integrated behavioral video telehealth intervention approach to reduce pain and alcohol use among heavy drinking HIV-infected patients with chronic pain and determine its feasibility and acceptability (UH2) and 2) obtain effect size estimates of intervention efficacy through a randomized controlled pilot trial (UH3). This study represents a first effort to utilize a video telehealth approach to address alcohol use and pain for patients this setting. The UH2 component will be used for treatment development and initial testing with a small sample of patients in an open pilot. Evidence of patient acceptability and feasibility in this setting along with pre-post changes in identified outcomes will provide data on which to base the UH3 component which will be a preliminary test of intervention efficacy through a randomized controlled pilot trial.