Brief couples-based alcohol intervention for HIV-infected MSM and their primary partners

对感染艾滋病毒的男男性行为者及其主要伴侣进行简短的基于夫妻的酒精干预

• 批准号: 9345106
• 负责人: Kristi E Gamarel
• 金额: $ 24.58万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-10 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9345106
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Alcohol consumption; Alcohols; Bisexual; Counseling; Couples; Data; Development; Drug usage; Elements; Foundations; Future; Gays; Goals; HIV; Health; Health behavior; Heavy Drinking; Individual; Intervention; Interview; Link; Liver diseases; Manuals; Modeling; Motivation; Outcome; Participant; Patients; Population; Preventive Intervention; Procedures; Protocols documentation; Public Health; Publishing; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reporting; Research; Resources; Risk; Sample Size; Self Efficacy; Specialist; Structure; Subgroup; Substance Use Disorder; Target Populations; Testing; Time; Training; Treatment Efficacy; United States; Viral; Viral Load result; Work; alcohol abstinence; alcohol abuse therapy; alcohol intervention; antiretroviral therapy; arm; base; behavior change; brief motivational intervention; cognitive function; comparative efficacy; cost effectiveness; drinking; drinking behavior; evidence base; follow-up; improved; informant; insight; intervention participants; liver function; male; member; men; men who have sex with men; mortality; motivational intervention; problem drinker; recruit; reduced alcohol use; satisfaction; sex; sex risk; sexual risk taking; skills; social; theories; therapy adherence; therapy development; uptake; viral detection

Project Summary Heavy alcohol use in HIV-infected patients contributes to suboptimal adherence to antiretroviral therapy (ART), greater sexual risk taking, higher viral loads, and worsened liver and cognitive functioning. Gay, bisexual, and other men who have sex with men (MSM) continue to represent almost half of all HIV/AIDS cases in the United States, and heavy drinking is particularly high among this HIV-infected sub-group. Brief motivational interventions have been shown to reduce alcohol consumption among HIV-infected MSM; however, these individual-level interventions have demonstrated only modest effects in reducing drinking in this population, indicating that sustained behavior change requires attending to social and interpersonal contexts as well. To date, there are no existing brief, couples-based interventions to address heavy alcohol use among HIV-infected MSM and their primary partners that do not require alcohol abstinence treatment goals. Furthermore, there are no published data on the extent to which changes in couples alcohol use relate to key HIV-related outcomes (ART adherence, viral suppression, sexual risk). The overall aim of this project is to develop and test the feasibility, acceptability, and preliminary efficacy of a brief couples-based motivational intervention to address heavy alcohol use among HIV-infected MSM and their primary partner. This treatment development project builds on our individual-level motivational intervention (MI) with HIV- infected MSM by using components from our significant other-involved motivational intervention (SO-MI) and couples-based HIV prevention interventions, and seeks to provide insights into the mechanisms of couple-level behavior change, including motivation, individual and dyadic self-efficacy, and partner support. A two-step sequence of treatment development will be used to achieve these aims. Stage 1a includes interviews with key informants (N = 15 couples), manual development, therapist training, and a one-arm pilot with qualitative exit interviews (N = 12 couples). Stage 1b consists of a small-randomized clinical trial in which 50 heavy drinking HIV-infected MSM will be randomly assigned to either couples intervention, which involves participation of their partner, or to the existing individual intervention, which does not. Both conditions will consist of four sessions conducted over a one-month period. Participants will be interviewed at baseline, and 3-months and 6-months. Findings will provide data on the feasibility, acceptability and preliminary efficacy of the couples-based motivational intervention to reduce alcohol use among HIV- infected MSM and their primary partners. If this research shows initial promise, we will use findings to support an R01 application to test the intervention efficacy in a fully powered randomized controlled trial. This research could provide a foundation for improving the health of HIV-infected heavy drinking MSM.

项目摘要 HIV感染者大量饮酒导致抗逆转录病毒治疗依从性欠佳 (ART)性风险增加，病毒载量增加，肝脏和认知功能恶化。同性恋， 双性恋者和其他男男性行为者仍然占所有艾滋病毒/艾滋病感染者的近一半 在美国，大量饮酒在这一艾滋病毒感染亚组中特别高。简要 动机干预已被证明可以减少感染艾滋病毒的男男性行为者的饮酒量; 然而，这些个人层面的干预措施在减少饮酒方面的效果有限， 这表明，持续的行为改变需要关注社会和人际关系， 上下文也是。到目前为止，还没有解决酗酒问题的简单的、以夫妇为基础的干预措施 在HIV感染的MSM及其不需要戒酒治疗的主要伴侣中使用 目标.此外，没有公开的数据表明， 与关键的艾滋病毒相关结果（抗逆转录病毒治疗依从性、病毒抑制、性风险）相关。其总体目标是 项目是开发和测试的可行性，可接受性，和一个简短的夫妇为基础的初步疗效 激励性干预，以解决艾滋病毒感染的男男性行为者及其主要伴侣之间的酗酒问题。 这个治疗开发项目建立在我们对艾滋病毒的个人层面的动机干预（MI）的基础上， 通过使用我们的重要他人参与的动机干预（SO-MI）的组件， 和夫妇为基础的艾滋病毒预防干预措施，并寻求提供深入了解的机制， 夫妇层面的行为改变，包括动机，个人和二元自我效能，和合作伙伴的支持。 为实现这些目标，将采用两步治疗开发序列。阶段1a包括 与关键知情人（N = 15对夫妇）的访谈，手动开发，治疗师培训和单臂 试点定性离职面谈（N = 12对夫妇）。阶段1b包括一项小型随机临床试验， 其中50名大量饮酒的HIV感染MSM将被随机分配到任何一对夫妇的干预， 涉及他们的合作伙伴的参与，或现有的个人干预，这并不。两 条件将包括在一个月内进行的四次会议。与会者将接受采访 在基线、3个月和6个月时。调查结果将提供关于可行性、可接受性和 以夫妇为基础的动机干预在减少艾滋病毒感染者饮酒方面的初步效果- 男男性接触者及其主要伴侣。如果这项研究显示出初步的希望，我们将利用研究结果， 支持R 01申请，以在完全把握度的随机对照试验中测试干预有效性。 本研究可为改善重度饮酒男男性接触者的健康状况提供依据。