Novel Extensions of Alcohol Contingency Management in People Living with HIV

项目概要 鉴于与认知和认知能力的关系，艾滋病毒感染者 (PLWH) 滥用酒精是一个公共卫生问题。 身体影响，随后可能会加速艾滋病毒的进展，增加传播的可能性， 加速相关合并症的发生。因此，需要采取有效的干预措施来减少艾滋病病毒感染者和艾滋病患者的饮酒。 具体来说，应急管理（CM；有形强化改变行为）是有效的 对一般人群进行酒精干预，但没有发表的研究专注于测试 CM PLWH 中的酒精滥用。我们当前的项目测试 30 天的 CM，包括 PLWH 的子样本 (U01 AA020797）的初步结果很有希望。尽管其功效显着，但人们仍然对 CM 仍然存在担忧 考虑到财务成本或负面行为再次出现的可能性，与长期可行性相关 加固结束。因此，需要采取一些方法将 CM 扩展到有限的时期之外，并使之成为现实。 适合广泛传播的方法。在这个拟议的 P01 组件项目（N=120）中，我们将 实施多项创新来解决可行性问题，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。我们的新颖方法将整合移动健康 （移动医疗）功能、酒精生物传感器和游戏化，可以通过社交增强参与度 联系和友好竞争。我们将通过招募更广泛的人来扩展我们当前的 CM 研究 参与者在 30 天的 CM 诱导期内的饮酒行为、年龄和合并症。生物- 确认将基于智能手机呼吸酒精读数和身份确认。我们的发现 表明大多数感染者在患有 CM 的情况下至少 30 天内避免大量饮酒，但相当少数人会这样做 并非如此，基于关键基线特征的结果预测很重要。 30天后，参与者 将进行动机访谈 (MI)，包括基于饮酒量减少的个性化反馈 使用，增强认知和/或身体功能。经过 30 天的 CM 诱导和 MI 后，响应者 将被随机分配到 3 种情况之一，以告知传播性 CM 的进展：1) 伴有间歇性 CM 强化，加上新颖的、基于移动医疗的游戏化； 2) CM 有间断强化，无 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，并且每周而不是每天 基础包括加强生物确认的饮酒节制，而不仅仅是禁欲。后续将会发生 60、90 和 180 天时。主要目标将测试禁欲期间禁欲天数百分比的增加幅度 30 天 CM 诱导和结果基线预测因素（例如饮酒严重程度、执行功能）。我们会 还测试戒酒作为认知、生物学和艾滋病毒结果的预测指标。此外，我们将 比较第二个 30 天 CM 期间 3 个研究条件的可接受性和初步疗效 期间。该项目是在 PLWH 中实施负担得起的、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.