Translational Methods for Developing and Testing a Multi-Target Brief Intervention to Reduce Alcohol Use and Increase ART Adherence among Racially Diverse PLWH

摘要 艾滋病毒携带者(PLWH)在酒精水平较低时会增加全因死亡的风险 与未感染的人相比，饮酒和更高水平的酒精相关问题被发现 在非裔美国人中，尽管饮酒量相当或更低。此外，酒精对人体的有害影响 据报道，在低收入城市人群中，抗逆转录病毒治疗的依从性和临床结果。此外，它是 建议PLWH接受常规酒精筛查，并以循证为基础的简短激励 当筛查呈阳性时，应采取干预措施。事实上，MI是公认的有效的 在广泛的患者中减少消耗，以依从性为重点的MI已被证明有所改善 PLWH之间的坚持。虽然有证据支持针对酒精和酒精的扩展干预 坚持是有希望的，多疗程干预通常很难对高危患者实施 而且还没有研究评估同时针对这两个目标的单次会议MI。 在许多艾滋病毒环境中，即使是短暂的预防措施的实施也存在障碍，例如竞争 需求密集，资源有限，缺乏专门针对酒精的专业知识。远程医疗技术提供了 可行的解决方案。我们的团队在开发有效的酒精为主的心肌梗死和多目标心肌梗死方面拥有专业知识。 解决酒精和性危险行为的交集问题。此外，我们有了一个新的理解 多目标短暂干预的科学，在这种科学中，可以干预共同发生的危险行为 和他们的互惠关系被利用。特别是，我们有概念证明数据支持多- 目标MI的研究结果表明，减少酒精可以进一步有助于减少性风险 行为。我们还展示了使用视频会议的后勤可行性和可接受性 在需求密集型环境中提供多目标MI的技术。这项建议利用我们的专业知识 在市中心为种族多元化的PLWH提供新颖的多目标视频会议MI(VMI)。 从翻译的角度来看，过程研究是一种告知干预的新方法 发展，特别是在干预措施短暂且有多个目标的情况下。例如，当 制定具有两个交叉目标的干预措施，迫切需要检查理想的显著程度 并对这些目标进行了排序。在第一阶段，我们将对现有的治疗过程进行新的分析 在短暂的心肌梗死中作为结果预测因子的专门检查行为目标显著度和排序的数据 在影响多种危险行为方面的有效性已知。结果将使我们能够优化显著程度和 在我们专门为达到以下目的而开发的新的多靶点MI中对酒精和依从性目标进行排序 高危ART不依从性患者。第一阶段将把工艺研究转化为治疗开发 优化多目标VMI的框架，以降低消耗并提高遵从性。第二阶段将 检查多目标VMI的有效性，以减少消耗并提高双重风险PLWH的依从性。

Abstract People living with HIV (PLWH) experience increased risk for all-cause mortality at lower levels of alcohol consumption compared to uninfected individuals and higher levels of alcohol-related problems are found among African Americans despite equivalent or lower drinking. Furthermore, deleterious effects of alcohol on ART adherence and clinical outcomes have been reported in low income urban populations. Moreover, it is recommended that PLWH receive routine alcohol screening, and that evidence-based brief motivational interventions (MI) be employed when they screen positive. Indeed, MI is well-established as efficacious in reducing consumption in a broad range of patients, and adherence-focused MI has been shown to improve adherence among PLWH. While evidence supporting extended interventions targeting both alcohol and adherence is promising, multi-session interventions are generally difficult to implement with high-risk patients and no study has evaluated a single-session MI targeting both. In many HIV settings, there are barriers preventing implementation of even brief MI, such as competing intensive demands, limited resources, and lack of alcohol-specific expertise. Telehealth technology offers a viable solution. Our team has expertise in developing efficacious alcohol-focused MIs and in multi-target MI addressing the intersection of alcohol and sexual risk behavior. Further, we have an emerging understanding of the science of multi-targeted brief intervention, where co-occurring risk behaviors can be intervened upon and their reciprocal associations exploited. In particular, we have proof of concept data supporting a multi- target MI with findings demonstrating reduction in alcohol can further contribute to reductions in sexual risk behavior. We have also demonstrated logistical feasibility and acceptability of using video-conferencing technology to deliver multi-target MI in a demand-intensive setting. This proposal leverages our expertise to deliver a novel, multi-target video-conferenced MI (vMI) to racially diverse PLWH in an inner-city setting. From a translational perspective, process research is a novel means of informing intervention development, particularly when interventions are brief and there are multiple targets. For example, when developing an intervention with 2 intersecting targets for change, it is imperative to examine the ideal salience and sequencing of these targets. In Phase I, we will conduct new analyses on existing therapeutic process data to specifically examine behavioral target salience and sequencing as predictors of outcome in a brief MI with known efficacy in affecting multiple risk behaviors. Results will allow us to optimize salience and sequencing of alcohol and adherence targets in our new multi-target MI developed specifically for reaching high-risk ART non-adherent patients. Phase 1 will translate process research into a treatment-development framework to optimize a multi-target vMI to reduce consumption and increase adherence. Phase II will examine efficacy of a multi-target vMI to reduce consumption and increase adherence among dual-risk PLWH.