FEASIBILITY AND PRELIMINARY EFFECTIVENESS OF A TRANSDIAGNOSTIC COGNITIVE BEHAVIORAL THERAPY TREATMENT APPROACH FOR ALCOHOL MISUSE INTEGRATED WITHIN HIV CARE IN ZAMBIA

赞比亚将酒精滥用跨诊断认知行为疗法纳入艾滋病毒护理的可行性和初步有效性

• 批准号: 10121170
• 负责人: Jeremy Calvin Kane
• 金额: $ 12.23万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-06 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10121170
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Africa; Africa South of the Sahara; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Behavior Therapy; Biological Markers; Caring; Clinic; Clinical; Clinical effectiveness; Cognitive Therapy; Country; Data; Databases; Development; Effectiveness; Elements; Enrollment; Environment; Epidemic; Epidemiology; Evidence based intervention; Evidence based treatment; Female; Focus Groups; Funding; Glucuronides; Goals; HIV; Health; Health care facility; Health system; Human Resources; Hybrids; Income; Individual; Inhalant dose form; Integrative Therapy; International; Intervention; Interview; Manuals; Measures; Mental Health; Methods; Modeling; National Institute of Allergy and Infectious Disease; Outcome; Participant; Patient Self-Report; Patients; Persons; Prevalence; Procedures; Program Development; Prospective cohort; Randomized; Reporting; Research; Resources; Severities; Structure; Symptoms; Testing; Therapeutic Intervention; Time; Training; United States National Institutes of Health; Urine; Viral; Viral Load result; Zambia; alcohol abstinence; alcohol abuse therapy; alcohol comorbidity; alcohol intervention; alcohol misuse; alcohol use disorder; antiretroviral therapy; base; behavioral health; brief alcohol intervention; brief intervention; cohort; comorbidity; cost effective; cost effectiveness; effective therapy; effectiveness implementation study; evidence base; follow-up; hazardous drinking; implementation strategy; improved; informant; innovation; male; mortality; novel; prospective; reduced alcohol use; response; standard of care; substance misuse; therapy adherence; therapy development; transmission process; treatment program; uptake; virtual

Alcohol use is increasing in sub-Saharan Africa (SSA) where it commonly intersects with the HIV/AIDS epidemic. Hazardous alcohol use increases HIV transmission, impedes uptake and retention on antiretroviral therapy (ART), and ultimately reduces HIV viral suppression (VS). Approximately 20-50% of persons living with HIV (PLWH) on ART drink hazardously; however, most clinics in SSA offer only brief interventions (BIs) for alcohol reduction that are ineffective for many patients. BIs have limited ability to address more severe alcohol use disorders (AUDs) or comorbid mental health or substance use issues (hereafter called `comorbidities') that are common among PLWH. In preliminary studies, we found that 40% of male and 20% of female PLWH on ART in Zambia had hazardous alcohol use, that ~60% failed to respond to current BIs, and that >50% had comorbidities. We previously developed and demonstrated the effectiveness of a novel cognitive-behavioral therapy intervention, Common Elements Treatment Approach (CETA), which trains lay health workers to address both AUDs and comorbidities. Our central hypothesis is that a stepped care approach to alcohol use, where interventions ranging in time and resource intensity are provided according to symptom severity, can be utilized by HIV treatment programs in SSA to effectively and efficiently address hazardous alcohol use and improve HIV outcomes. In this application, we propose a Stage 1 hybrid effectiveness-implementation study to adapt and pilot test CETA at two Zambian HIV clinics for PLWH who report hazardous alcohol use and are less likely to respond to BIs (i.e., those with moderate-to-severe alcohol use disorders (AUDs) and/or comorbidities). This project leverages (a) our development of CETA, (b) a prospective cohort of HIV-infected individuals that was created by the NIAID-funded International Epidemiological Databases to Evaluate AIDS, and (c) >10 years of HIV and mental health research in Zambia. Aim 1 will adapt the current CETA manual for HIV-infected individuals and HIV clinics with input from PLWH, health workers, and key informants in the health system. In Aim 2, PLWH who screen positive for hazardous alcohol use will be enrolled and assessed for AUD and comorbidities. Those with moderate-to-severe AUD and/or comorbidities (n=160) will be randomized 1:1 to receive BI alone or BI+CETA. Participants with subthreshold/mild AUD and without comorbidities will also receive the BI. Changes in alcohol use, comorbidities, and HIV outcomes (ART retention and HIV viral suppression) will be measured over 6 months of follow-up and the impact of the interventions will be evaluated. Urine Ethyl glucuronide testing will be used to augment self-reported alcohol measures. Aim 3 will investigate feasibility, acceptability, and other implementation factors related to delivery of BI and CETA. This study will: (1) result in an HIV-adapted CETA manual, (2) generate preliminary effectiveness and implementation data on CETA and BI in PLWH drinkers with comorbidities, and (3) inform an R01 application to further test a stepped care approach to address hazardous drinking in HIV care settings.

撒哈拉以南非洲（SSA）的饮酒正在增加，那里通常与艾滋病毒/艾滋病相交 流行性。危险饮酒会增加艾滋病毒的传播，阻碍抗逆转录病毒的吸收和保留。 治疗（ART），并最终减少HIV病毒抑制（VS）。约有20％至50％的人与 Art饮料上的艾滋病毒（PLWH）危险；但是，SSA中的大多数诊所仅提供简短的干预措施（BIS） 减少酒精对许多患者无效。 bis解决更严重的酒精的能力有限 使用疾病（AUDS）或合并症的心理健康或物质使用问题（以下称为“合并症”） 在PLWH中很常见。在初步研究中，我们发现男性中有40％和20％的女性PLWH 赞比亚的艺术有危险的酒精使用，约有60％的人无法对当前的bis做出反应，> 50％ 合并症。我们以前开发并证明了新型认知行为的有效性 治疗干预措施，常见元素治疗方法（CETA），培训外行卫生工作者 介绍澳元和合并症。我们的中心假设是一种阶梯式护理方法，用于饮酒， 如果根据症状严重程度提供了时间和资源强度的干预措施，则可以是 由SSA中的艾滋病毒治疗计划使用，可有效，有效地解决危险的酒精使用和 改善艾滋病毒结局。在此应用中，我们提出了一项1阶段的混合有效性研究研究 在两个赞比亚艾滋病毒诊所的适应和试点测试CETA，用于报告有害酒精的PLWH，并且较少 可能会响应BI（即，患有中度至重度酒精使用障碍（AUDS）和/或 合并症）。该项目利用（a）我们对CETA的发展，（b）艾滋病毒感染者的前瞻性队列 由NIAID资助的国际流行病学数据库创建的个人，以评估艾滋病， （c）>赞比亚10年的艾滋病毒和心理健康研究。 AIM 1将适应当前的CETA手册 艾滋病毒感染的个人和艾滋病毒诊所与PLWH，卫生工作者和卫生的主要线人的投入 系统。在AIM 2中，PLWH将在AUD上注册并评估阳性危险饮酒的PLWH 和合并症。那些具有中度至重度AUD和/或合并症（n = 160）的人将被随机分为1：1 单独接受BI或BI+CETA。具有子阈值/轻度AUD且没有合并症的参与者也将 接收BI。饮酒，合并症和HIV结果的变化（ART保留和HIV病毒 将在6个月的随访中测量抑制），并将评估干预措施的影响。 尿乙基葡萄糖醛酸乙糖测试将用于增强自我报告的酒精度量。 AIM 3将调查 与BI和CETA交付有关的可行性，可接受性和其他实施因素。这项研究将： （1）导致艾滋病毒适应的CETA手册，（2）生成初步有效性和实施数据 CETA和BI合并症的PLWH饮酒者，（3）通知R01申请进一步测试 在艾滋病毒护理环境中解决有害饮酒的护理方法。