Mobile technology to extend clinic-based counseling for HIV+s in Uganda

移动技术在乌干达扩大艾滋病毒临床咨询

• 批准号: 9906836
• 负责人: JUDITH ALISSA HAHN
• 金额: $ 31.28万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906836
• 关键词: Adherence; Africa South of the Sahara; Alcohol consumption; Alcohols; Anti-Retroviral Agents; Biological Markers; Blood; Car Phone; Caring; Cellular Phone; Clinic; Clinic Visits; Communities; Consumption; Counseling; Data; Development; Effectiveness; Failure; Fees; Focus Groups; Frequencies; Future; Gender; Goals; HIV; Health; Heavy Drinking; Hour; Human Resources; Individual; Intervention; Intervention Studies; Interview; Maintenance; Measures; Methods; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Persons; Population Heterogeneity; Prevalence; Professional counselor; Provider; Randomized Controlled Trials; Research; Resources; Rural; Schedule; Spottings; Surveys; System; Technology; Telephone; Testing; Text; Text Messaging; Time; Uganda; Viral; Visit; Voice; Waiting Lists; Work; alcohol intervention; alcohol misuse; arm; base; brief alcohol intervention; cost; cost estimate; design; drinking; experience; improved; intervention cost; member; mobile computing; mortality; phosphatidylethanol; post intervention; reduced alcohol use; response; satisfaction; screening; standard of care; successful intervention; tailored messaging; theories; three-arm study; uptake

Abstract Alcohol consumption is a critical predictor of poor HIV outcomes such as reduced antiretroviral adherence and lack of viral suppression. Reducing unhealthy alcohol use among those with HIV may improve HIV outcomes and thus is a high priority. HIV prevalence and unhealthy drinking rates are high in sub-Saharan Africa (SSA). Multi-session approaches to screening and brief counseling have good evidence for reducing alcohol use in resource rich settings and in persons with HIV. However, multiple in-person sessions are costly and unlikely to be scalable in SSA. Thus, there is a need to develop and test low-cost alternatives. A successful multi-contact alcohol intervention studied in the US uses phone-based booster sessions with a live counselor (“live boosters”) to reinforce the content of two brief in-person sessions. Because cell phone coverage is widespread in SSA, an intervention that uses live boosters may be feasible, particularly if the in-person sessions coincide with regular clinic visits. However, live booster calls can be labor intensive and dependent on a good phone network. Alternatively, automated booster sessions can be conducted via cell phone using short message service (SMS, i.e. text) or interactive voice response (IVR) systems, to provide brief 2-way interactive sessions (“tech boosters”). These systems are likely to be at low cost and burden to providers and patients. The SMS/IVR systems allow for tailoring the 2-way booster sessions on variables such as gender and drinking goals. The primary aims of this developmental study are (1) To adapt a successful alcohol intervention for unhealthy drinkers with HIV in Uganda to include in-person sessions that coincide with two routine quarterly clinic visits, with live booster calls delivered between in-person sessions, and to develop tech boosters as a scalable alternative to live calls. We will collect qualitative data via focus group discussions and individual in- depth interviews to elicit community and patient input into the content and delivery of the interventions. (2) To conduct a pilot randomized controlled trial (RCT) to test these methods for unhealthy drinkers in HIV care in rural Uganda (n=270). The study arms will be: (a) in-person counseling during 2 quarterly clinic visits plus live booster calls every 3 weeks in the interim, (b) in-person counseling during 2 quarterly clinic visits plus twice weekly tech (choice of SMS or IVR) boosters in the interim, and (c) standard of care control (brief unstructured advice, with a wait-listed intervention). We will obtain preliminary estimates of uptake, acceptability, cost, and efficacy in reducing alcohol use and decreasing viral failure for each study arm at six months. We will utilize an alcohol biomarker, phosphatidylethanol, in addition to self-reported alcohol use, and measure viral suppression via dried blood spots. This study will be conducted in a large rural Ugandan HIV clinic where we have 10 years of collaborating on alcohol/HIV research. The study will adapt a successful intervention and develop low-cost delivery methods, and the pilot RCT results will inform the design of a larger trial of a low-cost intervention to reduce alcohol use and increase viral suppression among those with HIV in SSA.

摘要 饮酒是艾滋病毒治疗效果不佳的一个重要预测因素，如抗逆转录病毒治疗依从性降低， 缺乏病毒抑制。减少艾滋病毒感染者不健康的酒精使用可能会改善艾滋病毒的结果 因此是高优先级的。撒哈拉以南非洲的艾滋病毒流行率和不健康饮酒率很高。 多阶段的筛查和简短的咨询方法有很好的证据表明， 资源丰富的环境和艾滋病毒感染者。然而，多次面对面的会议是昂贵的，不太可能 可在SSA中扩展。因此，有必要开发和测试低成本替代品。一次成功的多方接触 在美国进行的一项酒精干预研究中，使用了基于电话的现场咨询师（“现场 促进者”），以加强两个简短的面对面会议的内容。因为手机覆盖范围很广 在SSA中，使用现场助推器的干预可能是可行的，特别是如果面对面的会议重合 定期门诊。然而，现场助推器电话可以是劳动密集型的，并依赖于一个良好的手机 网络或者，可以通过手机使用短消息进行自动增强会话 服务（SMS，即文本）或交互式语音响应（IVR）系统，以提供简短的双向交互会话 （“技术助推器”）。这些系统可能成本低，对提供者和患者来说是负担。的 SMS/IVR系统允许根据性别和饮酒等变量定制双向助推器会话 目标.这项发展研究的主要目的是（1）适应成功的酒精干预， 乌干达艾滋病毒感染者的不健康饮酒者，包括与两个常规季度同时进行的面对面会议， 诊所访问，与现场助推器呼叫之间交付的人会议，并开发技术助推器作为一个 可扩展的实时呼叫替代方案。我们将通过焦点小组讨论和个人参与收集定性数据- 深入访谈，以征求社区和患者对干预措施的内容和实施的意见。(2)到 进行一项试验性随机对照试验（RCT），以测试这些方法对艾滋病毒护理中不健康饮酒者的影响， 乌干达农村（n=270）。研究组将为：（a）在2次季度门诊访视期间进行面对面咨询，加上现场 在此期间，每3周进行一次加强电话咨询，（B）在2次季度门诊访视期间进行面对面咨询，外加两次 每周一次的技术（选择短信或IVR）助推器在过渡期间，和（c）护理控制标准（简短的非结构化 建议，并列入等待干预名单）。我们将获得初步估计的吸收，可接受性，成本， 在六个月时，每个研究组减少酒精使用和减少病毒失败的有效性。我们将利用一个 酒精生物标志物磷脂酰乙醇，除了自我报告的酒精使用，并测量病毒抑制 通过干涸的血迹这项研究将在乌干达一个大型的农村艾滋病诊所进行，我们有10年的时间， 在酒精和艾滋病研究上的合作该研究将采用成功的干预措施，并开发低成本的 交付方法，试点随机对照试验的结果将通知设计一个更大的试验的低成本干预， 减少饮酒，增加SSA中艾滋病毒感染者的病毒抑制。