CHARTZ

图表

• 批准号: 10685464
• 负责人: Michael Jeffrey Vinikoor
• 金额: $ 31.12万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 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/10685464
• 关键词: 18 year old; Acceleration; Address; Adult; Affect; Africa South of the Sahara; Alabama; Alcohol abuse; Alcohol consumption; Alcohols; Behavioral; Biological Markers; Caring; Clinic; Clinical; Cognitive; Cognitive Therapy; Complex; Computerized Medical Record; Continuity of Patient Care; Counseling; Data; Diagnostic; Effectiveness; Elements; Eligibility Determination; Enrollment; Epidemic; HIV; HIV Infections; HIV/AIDS; Health Personnel; Hybrids; Incidence; Individual; Intervention; Measures; Mental Health; Mental disorders; Modeling; NIH Office of AIDS Research; Outcome; Outcome Measure; Participant; Patient Outcomes Assessments; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention program; Professional counselor; Program Research Project Grants; Protocols documentation; Provider; Psyche structure; Public Health; Public Sector; Randomized; Randomized Controlled Clinical Trials; Randomized, Controlled Trials; Research; Research Project Grants; Resource-limited setting; Symptoms; Testing; Translational trial; Trauma; Viral; Zambia; alcohol abuse therapy; alcohol comorbidity; alcohol intervention; alcohol misuse; antiretroviral therapy; arm; behavioral health; brief alcohol intervention; brief intervention; clinical care; comorbidity; comparative effectiveness; cost; cost effective; cost effectiveness; cost-effectiveness ratio; depressive symptoms; design; effectiveness evaluation; effectiveness/implementation trial; epidemic response; evidence base; experience; flexibility; follow-up; health goals; health related quality of life; implementation determinants; implementation evaluation; improved; incremental cost-effectiveness; intervention delivery; low and middle-income countries; marginalized population; mortality; novel; peer; phosphatidylethanol; pilot test; programs; psychologic; randomized trial; reduced alcohol use; response; screening; standard of care; substance use; therapy adherence; trauma symptom; treatment effect; treatment program; trial design

Project Summary/Abstract The intersection of unhealthy alcohol use and HIV infection is most significant in sub-Saharan Africa (SSA) where HIV prevalence exceeds 20% in some populations and alcohol consumption is on the rise. Most HIV treatment and prevention programs in SSA do not have evidence-based alcohol interventions and the professional mental health workforce is extremely limited. Alcohol brief interventions (BI), which have been moderately effective in other settings, were not effective in SSA for unhealthy alcohol use among people with HIV in several previous trials. Unhealthy alcohol use is often complicated by comorbid mental illness and/or other substance use. We previously demonstrated the feasibility, acceptability, and potential effectiveness of a transdiagnostic model called Common Elements Treatment Approach (CETA) for people with HIV and unhealthy alcohol use. CETA was designed for delivery by lay providers (non-professionals with limited or no previous mental health experience) and can address a range of conditions (including unhealthy alcohol use) within a single protocol delivered over 6-12 therapy sessions. CETA was evaluated in 3 previous randomized trials and found to be effective for a range of conditions in trauma-affected and marginalized populations. CETA HIV Alcohol Reduction Trial in Zambia (CHARTZ), a research project within the Zambia Alabama HIV Alcohol Comorbidities Program, is a hybrid effectiveness-implementation trial to evaluate the effects of CETA, and a novel alcohol BI, on HIV, alcohol, and comorbidity outcomes. Adults (18+ years old) with HIV, unhealthy alcohol use, and suboptimal engagement in HIV care at public sector HIV clinics in Lusaka will be enrolled and randomized to the standard of care (ART adherence counseling), BI alone, or BI plus CETA. The BI and CETA will be provided by HIV peer educators, a cadre of lay counselors who are embedded at HIV clinics across Zambia. Patient reported outcome measures (for alcohol use, mental illness, and other substance use) and HIV electronic medical records (for ART adherence, retention in HIV care, viral suppression) will be used to assess trial eligibility and evaluate outcomes at 6 and 12 months. Phosphatidylethanol, a direct alcohol biomarker, will be measured to strengthen assessment of trial outcomes. Implementation factors related to the integrated delivery of CETA and the BI will be evaluated including cost and cost effectiveness. In summary, CHARTZ will generate evidence on psychological treatments for unhealthy alcohol use that have strong potential for implementation in low-resource settings and can address complex and overlapping behavioral issues that undermine HIV treatment and prevention.

项目总结/摘要 不健康的酒精使用和艾滋病毒感染的交叉在撒哈拉以南非洲（SSA）最为显著， 艾滋病毒感染率在某些人群中超过20%，酒精消费量正在上升。大多数艾滋病毒治疗 SSA的预防计划没有基于证据的酒精干预措施， 保健工作人员极其有限。酒精短暂干预（BI），这是中度有效的， 在过去的几年中，在SSA中，艾滋病毒感染者使用不健康的酒精并不有效。 审判不健康的酒精使用通常会因共病精神疾病和/或其他物质使用而复杂化。我们 先前已经证明了跨诊断模型的可行性、可接受性和潜在有效性 一种针对艾滋病毒感染者和不健康饮酒者的共同要素治疗方法（CETA）。CETA 是专为提供外行供应商（非专业人士有限或没有以前的心理健康 经验），并且可以在单一协议中解决一系列条件（包括不健康的酒精使用） 在6-12个疗程中进行治疗。CETA在之前的3项随机试验中进行了评价，发现 对受创伤和边缘化人群的一系列情况有效。CETA艾滋病毒减少饮酒 赞比亚试验（CHARTZ）是赞比亚亚拉巴马艾滋病毒酒精合并症项目的一个研究项目， 是一项混合有效性-实施试验，旨在评估CETA和新型酒精BI对艾滋病毒的影响， 酒精和合并症的结果。成人（18岁以上）艾滋病毒感染者，不健康的酒精使用，以及次优 在卢萨卡的公共部门艾滋病毒诊所参与艾滋病毒护理将被招募，并随机分配到标准 治疗（ART依从性咨询），BI单独或BI加CETA。BI和CETA将由HIV同行提供 这是一群教育工作者，他们是赞比亚各地艾滋病毒诊所的非专业顾问骨干。患者报告结局 措施（用于酒精使用、精神疾病和其他物质使用）和艾滋病毒电子病历（用于ART 依从性、HIV护理中的保留、病毒抑制）将用于评估试验合格性和评价结局 在6个月和12个月。磷脂酰乙醇是一种直接的酒精生物标志物，将被测量以加强评估 审判结果。将评价与CETA和BI的综合交付相关的实施因素 包括成本和成本效益。总之，CHARTZ将提供心理治疗的证据， 在低资源环境下实施的潜力很大， 复杂和重叠的行为问题，破坏艾滋病毒的治疗和预防。