TALC

项目摘要 酒精使用障碍、物质使用障碍和精神健康共病是结束 艾滋病的流行。在美国的亚拉巴马和其他重点州尤其如此。 流行病的倡议。解决南方腹地不健康的酒精使用和心理健康共病问题， 由于贫困和缺乏公共卫生服务，由于在低资源领域面临类似的挑战， 为低收入和中等收入国家（LMIC）制定的干预措施有望减少 亚拉巴马艾滋病毒感染者（PLWH）的不健康饮酒和改善心理社会共病 对这一人群的影响不成比例旨在解决LMIC有限的心理健康工作人员， 共同元素治疗方法（CETA）是一种有前途的治疗不健康的酒精使用和精神疾病的方法。 亚拉巴马的健康共病CETA是一种基于多疗程认知行为治疗的干预， 采用transdiagnosis技术，以解决共病酒精使用，其他物质使用和心理健康， 症状通过一个单一的供应商。在至少7个低收入国家，社区教育援助已被证明是有效的， 减少抑郁症状和不健康的酒精滥用这项研究是一项随机试验， 使用CETA对艾滋病毒感染者不健康地使用酒精进行远程医疗（TALC研究）， 以下目的：1）评估T-CETA对PLWH中不健康酒精使用的有效性，2）评估 T-CETA对HIV结局的有效性，3）评价T-CETA对SUD和精神疾病的有效性 健康合并症，以及4）评价与向患有以下疾病的人提供BI和T-CETA相关的实施因素： 亚拉巴马社区诊所护理中的HIV不健康酒精使用，包括可行性、可接受性、成本和 成本效益。来自亚拉巴马社区HIV诊所的PLWH（n = 308）将入组本试验。 如果患者在经过验证的工具（AUDIT）上自我报告不健康的酒精使用情况， 每4 - 6个月作为常规护理的一部分。参与者将以1：1的比例随机接受短暂的酒精干预（BI） 对比BI + T-CETA（每组n = 154）。这是两个项目之一，旨在测试的有效性， CETA对居住在以下地区的PLWH中不健康的酒精使用，心理健康共病和艾滋病毒结果的影响 服务不足的地区。如果项目目标得以实现，它将极大地促进我们对战略的理解 减少亚拉巴马的艾滋病毒疾病进展和传播，并推进总统的"结束艾滋病计划"。 艾滋病毒流行。在达致这些目标后，我们计划进行多个地点的实施研究， 解决实施评估中发现的障碍（目标4），并将研究结果转化为日常工作 在美国南部其他重点州开展社区护理，以减少艾滋病毒感染。

Project Abstract Alcohol use disorders, substance use disorders, and mental health comorbidities are a major threat to ending the HIV epidemic. This is especially the case in Alabama and other priority states within the U.S. ‘Ending the HIV Epidemic’ initiative. Addressing unhealthy alcohol use and mental health comorbidities in the Deep South is made difficult by poverty and lack of public health services. Because of the similar challenges in low-resource settings, interventions developed for low and middle-income countries (LMIC) hold promise for reducing unhealthy alcohol use in people living with HIV (PLWH) in Alabama and improving psychosocial comorbidities that disproportionately impact this population. Designed to address the limited mental health workforce in LMIC, Common Elements Treatment Approach (CETA) is a promising treatment for unhealthy alcohol use and mental health comorbidities in Alabama. CETA is a multi-session cognitive behavioral therapy-based intervention that employs transdiagnostic techniques to address comorbid alcohol use, other substance use, and mental health symptoms through a single provider. CETA has been proven effective in at least 7 LMICs, with specific support for reducing depressive symptoms and unhealthy alcohol misuse. The proposed study is a randomized trial, Telemedicine for unhealthy Alcohol use in persons Living with HIV using CETA (TALC study), to achieve the following aims: 1) Evaluate the effectiveness of T-CETA on unhealthy alcohol use among PLWH, 2) Evaluate the effectiveness of T-CETA on HIV outcomes, 3) Evaluate the effectiveness of T-CETA on SUD and mental health comorbidities, and 4) Evaluate implementation factors related to BI and T-CETA provision to people with HIV unhealthy alcohol use in care at community clinics in Alabama including feasibility, acceptability, cost and cost-effectiveness. PLWH (n = 308) from community-based HIV clinics in Alabama will be enrolled in the trial. Patients will be eligible if they self-report unhealthy alcohol use on a validated tool (AUDIT), which is assessed every 4-6 months as part of routine care. Participants will be randomized 1:1 to a brief alcohol intervention (BI) versus BI plus T-CETA (n = 154 per arm). This is one of two program projects aiming to test the effectiveness of CETA on unhealthy alcohol use, mental health comorbidities, and HIV outcomes among PLWH residing in underserved areas. If the project aims are achieved, it will significantly advance our understanding of strategies to reduce HIV disease progression and transmission in Alabama and advance the President’s Plan to End the HIV Epidemic. Following achievement of these aims, we plan to conduct a multi-site implementation study to address barriers identified in the implementation assessment (Aim 4) and translate study findings into routine community care in other priority states for reducing HIV across the Southern U.S.