Couple-Based Motivational Interviewing with Technology to Reduce Alcohol Consumption in HIV+ South African Couples - Administrative Supplement

项目摘要/摘要(原建议书) 在撒哈拉以南非洲(SSA)，我们的研究建议主要伴侣应该与酒精有关 考虑到他们在帮助饮酒者减少饮酒方面的关键作用，以及夫妇之间的动态 与酒精的使用交叉。动机访谈(MI)是一种行之有效的减少饮酒的干预方法 在艾滋病毒携带者中，MI对夫妇来说是一个有希望的选择，而且越来越多的证据表明。 实时正确了解饮酒水平对于触发夫妻交流并及时和 提供量身定制的支持，帮助饮酒者减少饮酒。移动酒精测定仪技术可以帮助实现 这一目标是通过向情侣提供实时和客观的反馈来实现的，目前的应用程序已经内置了这一功能 并元函数。在这项研究中，我们建议开发和测试一种基于夫妇的酒精干预 MI和移动呼气测定仪，以在南非感染艾滋病毒的夫妇中建立围绕饮酒的二元支持。 我们假设，通过激励这对夫妇共同努力减少饮酒，并使用移动酒精测试仪作为 增加合作伙伴知识并触发合作伙伴沟通和及时支持的工具，我们将减少 大量饮酒和改善艾滋病毒治疗结果。具体目标是：(1)适应以夫妇为基础的 MI干预减少感染HIV的南非夫妇的酒精使用并加入酒精测定仪 使用移动应用程序向双方提供血液酒精含量(BAC)水平的实时反馈；(2) 为未来的夫妇随机对照试验(RCT)制定和中试研究程序 干预；以及(3)评估以夫妇为基础的MI干预的可行性和可接受性(F&A) 而且没有用于实时反馈的移动呼气测定仪。对于目标1，我们将采用基于夫妇的MI 解决南非饮酒问题的框架和干预措施(我们测试和夫妇健康项目) 配对并安装呼气测定器组件。对于目标2，我们将制定干预手册， 研究程序，以及将进行试点测试的数据收集工具。对于目标3，我们将实施三臂 随机对照试验将30对夫妇随机分成以下两组(总共90对夫妇)：1)增强的日常护理对照 条件；2)基于夫妇的MI；以及3)带有移动呼吸测定仪的夫妇MI以进行反馈。对于臂2和 情侣们将每月接受几次MI咨询，帮助情侣们加强关系 与饮酒有关的沟通和解决问题的能力。对于ARM 3，情侣们将使用手机 呼吸测定仪和APP为期60天，并接受相同的MI会议，其中还将纳入关于 BAC水平(30天前)，并教夫妇如何有效地使用呼气测定仪。我们将进行 退出对30对夫妇的访谈，以确定婚恋数据的背景，并将分析混合方法的数据 为将来的疗效试验完善干预措施。我们的长期目标是实现基于夫妇的MI 利用移动呼气测定仪技术进行实时反馈和支持的干预，可以 扩大规模，以减少酒精使用，加强夫妇支持，并改善SSA的艾滋病毒治疗结果。

Project Summary/Abstract (Original Proposal) In sub-Saharan Africa (SSA), our research suggests that primary partners should be involved in alcohol interventions given their critical role in helping drinkers reduce alcohol use and the couple dynamics that intersect with alcohol use. Motivational interviewing (MI) is a proven intervention for reducing alcohol use among individuals living with HIV, and emerging evidence suggests that MI is a promising option for couples. Correct knowledge of drinking levels in real-time is critical for triggering couple communication and timely and tailored support to help drinkers reduce their alcohol use. Mobile breathalyzer technology could help to achieve this goal by providing real-time and objective feedback to couples and current apps already have this built-in dyadic functionality. In this study, we propose to develop and test an alcohol intervention using couple-based MI and mobile breathalyzers to build dyadic support around drinking in HIV-affected couples in South Africa. We posit that by motivating the couple to work together to reduce drinking, and using mobile breathalyzers as a tool to increase partner knowledge and trigger couple communication and timely support, we will reduce heavy alcohol use and improve HIV treatment outcomes. The specific aims are to: (1) to adapt a couple-based MI intervention to reduce alcohol use in HIV-affected South African couples and incorporate a breathalyzer with mobile app to deliver real-time feedback on blood alcohol content (BAC) levels to both partners; (2) to develop and pilot test the study procedures for a future randomized controlled trial (RCT) of the couple-based intervention; and (3) to assess the feasibility and acceptability (F&A) of a couple-based MI intervention with and without mobile breathalyzers for real-time feedback. For Aim 1, we will adapt a couple-based MI framework and interventions (We Test and the Couples Health Project) to address alcohol use in South African couples and incorporate the breathalyzer component. For Aim 2, we will develop the intervention manuals, study procedures, and data collection instruments to be pilot tested. For Aim 3, we will implement a three-arm RCT with 30 couples randomized to the following arms (90 couples total): 1) an enhanced usual care control condition; 2) couple-based MI; and 3) couple-based MI with mobile breathalyzers for feedback. For arm 2 and 3, couples will receive several monthly MI sessions with a lay counselor to help couples strengthen communication and problem-solving skills around alcohol use. For Arm 3, couples will use the mobile breathalyzers and app for 60 days and receive the same MI sessions, which will also incorporate feedback on BAC levels (prior 30 days) and teach couples how to effectively engage with the breathalyzers. We will conduct exit interviews with a subset of 30 couples to contextualize F&A data, and will analyze the mixed-methods data to refine the intervention for a future efficacy trial. Our long-term goal is to implement a couple-based MI intervention that leverages the mobile breathalyzer technology for real-time feedback and support, and can be scaled-up to reduce alcohol use, strengthen couple support, and improve HIV treatment outcomes in SSA.