Novel Extensions of Alcohol Contingency Management in People Living with HIV

项目总结 艾滋病毒携带者(PLWH)的酒精滥用是一个公共卫生问题，因为它与认知和 物理效应，这可能随后加速艾滋病毒的进展，增加传播和 加速相关的合并症。因此，需要采取有效的干预措施来减少PLWH患者的酒精使用。 具体来说，应急管理(CM；改变行为的有形强化)一直是有效的 在一般人群中进行酒精干预，但还没有发表的研究集中于测试CM PLWH中的酒精滥用。我们当前的项目测试30天CM，包括PLWH(U01)的一个子样本 AA020797)有很有希望的初步发现。尽管CM有效，但人们对CM的担忧通常 与长期可行性有关，考虑到财务成本，或负面行为在以下情况下重新出现的可能性 加固结束。因此，需要一种方法来将CM扩展到有限的期限之外，并使其 可广泛传播的方法。在这个拟议的P01组件项目(N=120)中，我们将 实施几项创新，以解决可行性问题，并着眼于使用实施进行研究 社区卫生中心和诊所的科学方法。我们的新方法将引领移动医疗 (MHealth)能力、酒精生物传感器和游戏化，这可能会通过社交提高参与度 人脉和友好竞争。我们将扩大我们目前的CM研究，招募更广泛的 在为期30天的CM诱导期内，参与者关于饮酒行为、年龄和合并症的情况。生物- 确认将基于智能手机呼气酒精读数和身份确认。我们的发现 表明大多数PLWH在服用CM后至少30天内避免大量饮酒，但相当一部分人这样做 不是，这使得基于关键基线特征的结果预测变得重要。30天后，参与者 将参加激励性面试(MI)，包括基于减少饮酒的个性化反馈 使用，增强认知和/或身体功能。在30天的CM诱导和MI之后，应答者 将随机分为3种情况之一，以告知可传播CM的进展情况：1)CM间歇性 强化，外加新颖的基于mHealth的游戏化；2)无间歇性强化的CM 游戏化；3)或非偶然强化(控制条件)。在这个创新的，第二个30天的时间里， 加强将基于手腕生物传感器，而不是呼吸酒精读数和每周而不是每天 基础包括加强生物确认的饮酒节制，而不仅仅是禁欲。将会有后续行动 60天、90天和180天。主要目标将测试戒酒天数百分比的增加幅度 30天CM诱导和基线结果预测因素(例如，饮酒严重程度、执行功能)。我们会 也要测试戒酒作为认知、生物学和艾滋病毒结果的预测指标。此外，我们还将 在第二次、30天的CM中，比较3种研究条件的可接受性和初步疗效 句号。该项目是在PLWH实施负担得起的、基于技术的酒精CM的第一步。

PROJECT SUMMARY Alcohol misuse in people living with HIV (PLWH) is a public health issue given relationships to cognitive and physical effects, which may subsequently accelerate HIV progression, increase likelihood of transmission and hasten related comorbidities. Thus, efficacious interventions to reduce alcohol use in PLWH are needed. Specifically, contingency management (CM; tangible reinforcement to change behavior) has been efficacious for alcohol intervention in the general population, but there are no published studies focused on testing CM for alcohol misuse in PLWH. Our current project testing 30-day CM including a subsample of PLWH (U01 AA020797) has promising preliminary findings. Despite its efficacy, remaining concerns about CM typically relate to long-term feasibility given financial costs or the possibility that negative behaviors will return when reinforcement ends. Thus, there is a need for approaches to extend CM beyond a limited period and make this approach amenable to wide dissemination. In this proposed P01 component project (N=120), we will implement several innovations to address feasibility concerns with an eye to research using implementation science methods in community health centers and clinics. Our novel approach will marshal mobile health (mHealth) capabilities, alcohol biosensors and gamification, which may enhance engagement through social connections and friendly competition. We will extend our current CM research by enrolling a wider range of participants regarding drinking behavior, age and comorbidities in a 30-day CM induction period. Bio- confirmation will be based on smartphone breath alcohol readings with identity confirmation. Our findings indicate the majority of PLWH avoid heavy drinking for at least 30 days with CM but a considerable minority do not, making prediction of outcome based on key baseline characteristics important. After 30 days, participants will be engaged in a motivational interview (MI) including personalized feedback based on reductions in alcohol use, enhanced cognitive and/or physical functioning. Following the 30-day CM induction and MI, responders will be randomized to 1 of 3 conditions to inform progress toward disseminable CM: 1) CM with intermittent reinforcement, plus novel, mHealth-based gamification; 2) CM with intermittent reinforcement without gamification; 3) or non-contingent reinforcement (control condition). In this innovative, second 30-day period, reinforcement will be based on wrist biosensor not breath alcohol readings and on a weekly rather than daily basis including reinforcement for bio-confirmed drinking moderation, not only abstinence. Follow-up will occur at 60, 90 and 180 days. Primary aims will test the magnitude of increases in percent days abstinent during the 30-day CM induction and baseline predictors of outcome (e.g., drinking severity, executive function). We will also test alcohol abstinence as a predictor of cognitive, biological and HIV outcomes. In addition, we will compare acceptability and preliminary efficacy across the 3 study conditions during the second, 30-day CM period. This project is an initial step to implement affordable, technology-based CM for alcohol in PLWH.