Novel Extensions of Alcohol Contingency Management in People Living with HIV

艾滋病毒感染者酒精应急管理的新扩展

• 批准号: 10682456
• 负责人: ROBERT F LEEMAN
• 金额: $ 42.33万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682456
• 关键词: Abstinence; Acceleration; Address; Age; Agreement; Alcohol consumption; Alcohols; Behavior; Biological; Biosensor; Cellular Phone; Characteristics; Clinic; Cognition; Cognitive; Consumption; Enrollment; Eye; Failure; Feedback; Financial cost; Friends; General Population; HIV; HIV Infections; Health; Health behavior; Healthcare Systems; Heavy Drinking; IL6 gene; Inflammation; Intervention; Liquid substance; Methods; Minority; Monitor; Neighborhood Health Center; Outcome; Participant; Persons; Physical Function; Population; Psychological reinforcement; Public Health; Publishing; Randomized; Research; Risk; Risk Factors; Sampling; Severities; TNF gene; Technology; Testing; Viral Load result; Wrist; alcohol abstinence; alcohol intervention; alcohol misuse; alcohol research; alcohol testing; behavior change; cognitive enhancement; cognitive function; comorbidity; contingency management; cost; drinking; drinking behavior; efficacious intervention; executive function; follow-up; gut-brain axis; implementation science; improved; innovation; mHealth; motivational enhancement therapy; novel; novel strategies; outcome prediction; patient engagement; reduced alcohol use; sensor technology; social; substance misuse; systemic inflammatory response; transmission process; usability; user-friendly

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.

项目摘要 艾滋病毒感染者（PLWH）的酒精滥用是一个公共卫生问题，因为它与认知和 身体上的影响，这可能会加速艾滋病毒的进展，增加传播的可能性， 加速相关的合并症。因此，需要有效的干预措施来减少艾滋病毒携带者的酒精使用。 具体来说，应急管理（CM;有形强化改变行为）一直是有效的 在一般人群中进行酒精干预，但没有发表的研究集中在测试CM PLWH中的酒精滥用。我们目前的项目测试30天CM，包括PLWH（U 01）的子样本 AA 020797）有着令人鼓舞的初步发现。尽管它的疗效，其余的关注厘米通常 与长期可行性有关，考虑到财务成本或当 加固结束。因此，有必要采取办法，将变革管理延长到有限的时期之外， 方法适合广泛传播。在本拟定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，并着眼于利用实施进行研究 社区卫生中心和诊所的科学方法。我们的新方法将引导移动的健康 （mHealth）能力，酒精生物传感器和游戏化，这可能会通过社交网络增强参与度。 联系和友好的竞争。我们将通过招募更广泛的 在为期30天的CM诱导期内，对参与者的饮酒行为、年龄和合并症进行研究。生物- 确认将基于具有身份确认的智能手机呼吸酒精读数。我们的研究结果 表明大多数PLWH避免大量饮酒至少30天与CM，但相当少的人这样做 而不是根据关键基线特征预测结果。30天后，参与者 将参与动机访谈（MI），包括基于酒精减少的个性化反馈 使用，增强认知和/或身体功能。在30天CM诱导和MI后，应答者 将被随机分配至3种情况之一，以告知可传播CM的进展：1）间歇性CM 强化，加上新的，基于mHealth的游戏化; 2）CM与间歇性强化， 游戏化; 3）或非偶然强化（控制条件）。在这个创新的第二个30天期间， 强化将基于手腕生物传感器，而不是呼吸酒精读数，每周而不是每天 基础包括强化生物确认的饮酒适度，而不仅仅是戒酒。将进行随访 在60、90和180天。主要目标将测试在2010年期间禁欲天数百分比增加的幅度。 30-天CM诱导和结果的基线预测因子（例如，饮酒严重程度、执行功能）。我们将 同时也将戒酒作为认知、生物学和艾滋病结果的预测指标。此外，我们将 在第二个30天CM期间，比较3种研究条件的可接受性和初步疗效 期该项目是在艾滋病毒/艾滋病感染者中实施负担得起的、基于技术的酒精预防措施的第一步。