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

项目概要/摘要（原始提案） 在撒哈拉以南非洲（SSA），我们的研究表明，主要合作伙伴应该参与酒精 鉴于干预措施在帮助饮酒者减少饮酒方面的关键作用， 与酗酒有关动机访谈（MI）是一种行之有效的减少饮酒的干预措施 在艾滋病毒感染者中，新出现的证据表明，MI是夫妇的一个有希望的选择。 实时正确了解饮酒水平对于触发夫妻沟通和及时 量身定制的支持，以帮助饮酒者减少酒精使用。移动的呼气测醉技术可以帮助实现 通过向情侣提供实时和客观的反馈来实现这一目标，目前的应用程序已经内置了这一功能。 二元函数在这项研究中，我们建议开发和测试酒精干预使用夫妇为基础的， MI和移动的呼气测醉器在南非受艾滋病毒影响的夫妇中围绕饮酒建立二元支持。 我们通过激励这对夫妇共同努力减少饮酒，并使用移动的呼气测醉器作为 一个工具，以增加合作伙伴的知识和触发夫妇沟通和及时的支持，我们将减少 酗酒和改善艾滋病毒治疗结果。其具体目标是：（1）适应以夫妻为基础的 MI干预，以减少受艾滋病毒影响的南非夫妇的酒精使用，并结合呼吸测醉器 通过移动的应用程序向伴侣双方提供血液酒精含量（BAC）水平的实时反馈;（2） 为未来的基于夫妇的随机对照试验（RCT）开发和初步测试研究程序 （3）评估基于夫妇的MI干预的可行性和可接受性（F&A）， 并且没有移动的呼吸测醉器用于实时反馈。对于目标1，我们将采用基于夫妇的MI 解决南非酗酒问题的框架和干预措施（我们测试和夫妇健康项目） 耦合并结合呼吸测醉器组件。对于目标2，我们将编写干预手册， 研究程序和数据收集工具进行试点测试。对于目标3，我们将实施三臂 随机对照试验，30对夫妇被随机分配到以下组（共90对夫妇）：1）强化常规护理对照 条件; 2）基于夫妇的MI;和3）基于夫妇的MI，使用移动的呼吸测醉器进行反馈。对于臂2和 3，夫妇将接受几个月的MI会议与外行顾问，以帮助夫妇加强 沟通和解决酒精使用问题的技能。对于第3组，夫妇将使用移动的 呼吸测醉器和应用程序60天，并收到相同的MI会议，这也将纳入反馈， BAC水平（前30天），并教夫妇如何有效地与呼气测醉器。我们会进行 与30对夫妇的一个子集进行退出访谈，以将F&A数据置于情境中，并将分析混合方法数据 为将来的疗效试验完善干预措施。我们的长期目标是实施以夫妇为基础的MI 利用移动的呼吸测醉器技术进行实时反馈和支持的干预， 在撒哈拉以南非洲，扩大了减少饮酒、加强夫妇支持和改善艾滋病毒治疗结果的规模。

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.