Impact of a Computer-Assisted SBIRT Program in an HIV Care Setting

描述（由申请人提供）：计算机辅助的SBIRT项目在HIV护理环境中的影响本申请涉及广泛的挑战领域（04）临床研究和特定的挑战主题，04- da - 110：筛选，简短干预和转诊治疗。许多研究表明，感染艾滋病毒的患者使用药物/酒精与发病率和死亡率之间存在关系。其他研究也证明了药物/酒精使用与高风险艾滋病毒传播风险行为之间的关系，包括与艾滋病毒血清检测呈阴性的伴侣进行无保护的肛交和阴道性交。然而，即使有这些有记录的关系，在艾滋病毒初级保健机构中，药物和酒精的使用往往没有得到解决。筛查、短暂干预和转诊治疗（SBIRT）策略已被发现在许多人群中是有效的，但药物/酒精使用的SBIRT尚未在艾滋病毒初级保健环境中进行过测试。因此，拟议项目的目标是评估在旧金山总医院积极健康计划（PHP）的艾滋病毒初级保健环境中，SBIRT对有害酒精使用、非法药物使用和阿片类镇痛药使用的影响。具体而言，该项目旨在检查和比较通过(1)自我管理的基于网络的个人健康记录与(2)在诊所预约期间由提供者管理的协议进行SBIRT的可行性、可接受性和影响。将采用随机、双组队列研究方法。300名hiv阳性的临床患者将被登记，并将通过基于网络的系统（称为myHERO）或从提供者处获得SBIRT，结果将输入电子医疗记录系统（称为HERO）。参与者将进行四次研究访问（基线、1个月、3个月、6个月）。SBIRT将在基线和6个月时进行。筛查工具将包括“酒精、吸烟和物质介入筛查测试”和“酒精使用障碍识别测试”。筛查工具得分和解释将被添加到患者电子病历中的活动问题列表中，并将提醒提供者需要进行随访。简短的干预和转诊治疗将由接受过药物使用咨询和动机性访谈技术培训的诊所社工提供。在所有四次访问中，将对参与者进行结果指标评估，包括酒精和药物使用、艾滋病毒传播风险行为和抗逆转录病毒药物依从性。加强艾滋病毒阳性健康方案（PHP）的能力，以便对药物使用情况进行标准化筛查，并在需要时采取系统的方法进行短暂干预，并根据需要转诊进行更深入的治疗，这有可能解决艾滋病毒感染门诊患者中可预防的健康问题。更广泛地说，该项目有可能降低艾滋病毒阳性者的发病率和死亡率，利用技术创新提高诊所护理质量，并增加患者对自身健康和保健的参与。

DESCRIPTION (provided by applicant): Impact of a Computer-Assisted SBIRT Program in an HIV Care Setting This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04-DA- 110: Screening, Brief Intervention, and Referral to Treatment. Many studies have demonstrated the relationship between drug/alcohol use in HIV infected patients and morbidity and mortality. Other studies have demonstrated a relationship between drug/alcohol use and high- risk HIV transmission risk behaviors, including unprotected anal and vaginal intercourse with HIV seronegative partners. Even with these documented relationships, however, drug and alcohol use is often not addressed with patients in HIV primary care settings. The screening, brief intervention, and referral to treatment (SBIRT) strategy has been found to be effective in a number of populations, but SBIRT for drug/alcohol use has not been tested in an HIV primary care setting. Therefore, the goal of the proposed project is to assess the impact of SBIRT for harmful alcohol use, illicit drug use, and opioid analgesic use in an HIV primary care setting at San Francisco General Hospital's Positive Health Program (PHP). Specifically, the project aims to examine and compare the feasibility, acceptability and impact of conducting SBIRT through (1) a self-administered, web-based Personal Health Record compared to (2) a provider-administered protocol during clinic appointments. A randomized, two-arm cohort methodology will be used. Three hundred HIV-positive clinic patients will be enrolled, and will receive the SBIRT either through the web-based system (called myHERO), or from a provider with results entered into the electronic medical record system (called HERO). Participants will be seen for four study visits (baseline, 1 Month, 3 Months, 6 Months). SBIRT will be conducted at baseline and at 6 Months. The screening instruments will include the "Alcohol, Smoking and Substance Involvement Screening Test" and "The Alcohol Use Disorders Identification Test." The screening tool scores and interpretation will be added to the Active Problem List in the patient's electronic medical record, and will alert the provider to the need for follow-up. The brief intervention and referral to treatment will be delivered by a clinic- based social worker trained in substance use counseling and motivational interviewing techniques. Participants will be assessed at all four visits for the outcome indicators including alcohol and drug use, HIV transmission risk behaviors, and antiretroviral medication adherence. Enhancing the capacity of the HIV Positive Health Program (PHP) to implement standardized screening for substance use and, when indicated, a systematic approach to brief intervention and referral for more in-depth treatment as needed, has the potential to address preventable health problems among HIV infected clinic patients. More broadly, the project has the potential to reduce morbidity and mortality among HIV-positive people, use technological innovation to improve clinic quality of care, and increase engagement of patients in their own health and healthcare. PUBLIC HEALTH RELEVANCE: Despite research with HIV-positive patients showing relationships between drug/alcohol use and increased morbidity, mortality, and HIV transmission risk behaviors, many HIV primary care providers do not address drug and alcohol use with their patients. The purpose of this study is to test two mechanisms for screening patients for alcohol and drug use, for conducting a brief intervention, and for referring people for specialized care: (1) a web-based personal health record, and (2) a provider-administered protocol during clinic appointments. If these mechanisms are found to be effective, they may reduce morbidity and mortality among HIV-positive patients, and could be adapted for use with other illnesses.