Primary Care-Based Interventions to Reduce Alcohol Use Among HIV Patients

描述（由申请人提供）：本申请响应RFA-AA-12-009，改善HIV/AIDS和酒精相关结局的干预措施（U 01）。拟议的研究在艾滋病毒初级保健诊所进行，并使用健康计划的电子病历（EMR）进行筛查;它有可能通过减少危险饮酒和相关并发症为艾滋病毒感染者提供显着益处。先前的研究已经确定了艾滋病毒和危险饮酒（定义为饮酒超过阈值限制，即，男性每天5+或每周14+杯，女性每天4+或每周7+杯）。在这些水平上饮酒会影响抗逆转录病毒（ART）治疗，并增加抑郁症，不安全性行为和死亡率。拟议的随机试验检查了两种高度可实施的行为干预措施对减少危险饮酒的比较有效性，每种干预措施都有一个适应性的分步护理组成部分：1）动机访谈（MI），包括与研究临床医生的一次面对面会议和两次电话会议，对于那些在6个月内报告危险饮酒的人，还有三次额外的电话会议;以及2）使用集成到电子病历（EMR）中的安全消息传递系统对危险饮酒风险进行交互式电子邮件反馈（EF），并为6个月时报告危险饮酒的人提供额外的电子邮件反馈。第三只手臂将是常规护理。我们还将评估这两种干预措施的成本效益，这两种干预措施有可能在其他类似的医疗保健环境中广泛采用。两个拟议的干预措施，MI和EF，是有前途的方法，减少危险饮酒的行为健康和/或初级保健的设置。EF还使用安全消息传递，这是一种新兴技术，已在其他健康，行为改变和心理健康治疗环境中进行了测试，用于包括酒精使用在内的问题，但不适用于艾滋病毒感染者。在本试验中，将从Kaiser Permanente北方加州（KPNC）旧金山弗朗西斯科招募600例患者（每组200例）。研究人群和诊所是检查此类干预措施的理想选择，因为基于NIAAA的筛查问题记录在EMR中，并且可以获得有关医疗保健利用，ART依从性和HIV临床结局的全面数据，包括退伍军人老龄化队列研究（VACS）指数，这是一种基于常规临床实验室测量的最近验证的预后指数。该研究团队在临床心理学，药物和酒精滥用治疗，艾滋病毒流行病学和生物统计学方面具有互补的专业知识。因此，该团队和研究环境提供了测试MI和EF的理想环境，这是减少该人群危险酒精使用的两种创新方法，并可能为帮助艾滋病毒感染者提供强大的，可推广的工具。

DESCRIPTION (provided by applicant): This application responds to RFA-AA-12-009, Interventions to Improve HIV/AIDS and Alcohol-Related Outcomes (U01). The proposed study takes place in a HIV primary care clinic and uses the health plan's electronic medical record (EMR) for screening; it has the potential to provide a significant benefit to HIV- infected individuals by reducing hazardous drinking and the associated complications. Prior studies have identified high rates of co-occurrence of HIV and hazardous drinking (defined as drinking over threshold limits, i.e., 5+ daily or 14+ weekly drinks for men and 4+ daily or 7+ weekly drinks for women). Drinking at these levels can compromise antiretroviral (ART) treatment and increase rates of depression, unsafe sex, and mortality. The proposed randomized trial examines the comparative effectiveness of two highly implementable behavioral interventions for reducing hazardous drinking, each with an adaptive, stepped-care component: 1) Motivational Interviewing (MI), consisting of one in-person session with a study clinician and two phone sessions, with three additional phone sessions for those who report hazardous drinking at 6 months; and 2) interactive Emailed Feedback (EF) on hazardous drinking risks using a secure messaging system integrated into the Electronic Medical Record (EMR), with additional emailed feedback for those who report hazardous drinking at 6 months. A third arm will be usual care. We will also evaluate the cost-effectiveness of the two interventions which have the potential for wide adoption in other similar healthcare settings. The two proposed interventions, MI and EF, are promising approaches for reducing hazardous drinking in the setting of behavioral health and/or primary care. EF also uses secure messaging, an emerging technology that has been tested in other health, behavior change and mental health treatment settings, for problems including alcohol use but not among HIV-infected individuals. In this trial, 600 patients (200 in each arm) will be recruited from Kaiser Permanente Northern California (KPNC) San Francisco. The study population and clinic are ideal to examine such interventions since NIAAA-based screening questions are recorded in the EMR, and comprehensive data are available on health care utilization, ART adherence, and HIV clinical outcomes, including the Veterans Aging Cohort Study (VACS) index, a recently validated prognostic index based on routine clinical laboratory measures. The research team is well-qualified with complementary expertise in clinical psychology, drug and alcohol abuse treatment, HIV epidemiology, and biostatistics. Thus, the team and study setting provide the ideal environment to test MI and EF, two innovative approaches for reducing hazardous alcohol use in this population, and may provide powerful, generalizable tools for assisting individuals with HIV infection.