HealthCall: Enhancing brief intervention for HIV primary care alcohol dependence

描述(申请人提供)：在艾滋病毒携带者中，大量饮酒预示着抗逆转录病毒疗法(ART)的依从性较差，并通过对肝脏的有害影响大幅增加死亡率和发病率。因此，迫切需要有效和可扩展的饮酒干预措施，以改善大量饮酒的艾滋病毒患者的健康和生存。对非依赖型普通初级保健患者进行短暂的饮酒干预是有效的，但酒精依赖型患者需要更广泛的干预。针对艾滋病毒人群的经过测试的减少饮酒干预措施需要相当多的人员时间。为了在不增加工作人员时间的情况下延长对艾滋病毒诊所的短暂干预，我们利用通信技术开发了HealthCall，这是对城市艾滋病毒患者短暂减少饮酒干预的创新增强。HealthCall使用技术让患者在60天内对饮酒、抗逆转录病毒治疗的依从性和其他健康行为进行简短的日常自我监测。然后为患者汇总自我监测数据，提供个性化反馈，供30天和60天的简短审查和讨论。患者对HealthCall的满意度很高。重要的是，在城市酒精依赖的艾滋病毒初级保健患者中，我们表明HealthCall在结合简短的激励性访谈(MI；MI+HealthCall)时在减少大量饮酒方面是有效的。从那时起，形成性工作也表明了提高HealthCall对抗逆转录病毒治疗(ART)坚持的关注的方法。MI是理论驱动的、循证的和有效的，但需要仔细的培训、监督和技能才能成功。将HealthCall与更具可扩展性的短暂干预相结合，将提供更广泛的公共健康好处。NIAAA推荐临床医生指南(CG)作为对没有咨询背景的卫生保健人员进行酒精干预的简短、循证的方法。与MI相比，CG需要更少的培训和特定技能，因此当与HealthCall配合使用时，可能会降低成本并提高可扩展性。CG也可以很容易地融入对艺术坚持的关注。我们提出了一项随机试验，以比较MI+HealthCall、CG+HealthCall和仅CG-在三个不同城市HIV诊所的300名讲英语或西班牙语的HIV患者中的作用。主要结果是减少饮酒。重要的次要结果是抗逆转录病毒疗法的依从性、病毒载量、艾滋病病毒治疗中的滞留、吸烟以及每次干预的相对成本。我们还将探索是否可以治疗 对饮酒的影响受场所或患者特征的影响，并由基于理论的机制(对改变的承诺；自我效能)调节。疗效的持久性将通过12个月的随访进行评估。我们的科学团队在酒精、ART坚持、以技术为基础的简短干预和成本分析方面拥有专业知识，因此为成功的研究做好了准备。作为对PA-13-121的回应，这项研究将提供有关HealthCall在减少艾滋病毒酒精依赖患者饮酒方面的有效性的信息，当与两种扩展潜力不同的基于证据的简短干预措施配合使用时，满足创新但基于证据的简短干预措施的需求，以改善酒精依赖艾滋病毒患者的健康和生存。

DESCRIPTION (provided by applicant): Among those with HIV, heavy drinking predicts poor antiretroviral therapy (ART) adherence, and substantially increases mortality and morbidity through harmful effects on the liver. Thus, effective and scalable drinking interventions are urgently needed to improve the health and survival of heavy-drinking HIV patients. Brief drinking interventions in non-dependent general primary care patients are effective, but alcohol dependent patients need more extensive intervention. Tested drinking-reduction interventions for HIV populations require considerable personnel time. To extend brief intervention in the HIV clinic with little extra demand on staff time, we harnessed communication technology to develop HealthCall, an innovative enhancement of brief drinking- reduction intervention for urban HIV patients. HealthCall uses technology to engage patients in brief daily self- monitoring of drinking, ART adherence, and other health behaviors over 60 days. The self-monitoring data are then summarized for patients, providing personalized feedback for brief review and discussion at 30 and 60 days. Patient satisfaction with HealthCall is high. Importantly, in urban alcohol dependent HIV primary care patients, we showed that HealthCall is effective at reducing heavy drinking when paired with brief Motivational Interviewing (MI; MI+HealthCall). Since then, formative work also indicated ways to increase HealthCall focus on antiretroviral therapy (ART) adherence. MI is theory-driven, evidence-based, and effective, but requires careful training, supervision and skill for successful outcome. Pairing HealthCall with a more scalable brief intervention would offer wider public health benefits. NIAAA recommends the Clinician's Guide (CG) as a brief, evidence-based approach to alcohol intervention for health care personnel who do not have counseling backgrounds. Compared to MI, CG requires less training and specific skills, thus potentially lowering costs and improving scalability when paired with HealthCall. CG also can readily incorporate attention to ART adherence. We propose a randomized trial to compare MI+HealthCall, CG+HealthCall and CG-only in 300 English- or Spanish-speaking alcohol dependent HIV patients at three diverse urban HIV clinics. The primary outcome is drinking reduction. Important secondary outcomes are ART adherence, viral load, and retention in HIV care, smoking, and the relative cost of each intervention. We will also explore if treatment effects on drinking are moderated by site or patient characteristics, and mediated by theoretically based mechanisms (commitment to change; self-efficacy). Durability of effects will be assessed through 12-month follow-up. Our scientific team has expertise in alcohol, ART adherence, technology-based brief interventions, and cost analysis, and is thus well positioned for a successful study. Responding to PA-13-121, this study will provide information on the efficacy of HealthCall to reduce drinking in HIV alcohol dependent patients when paired with two brief, evidence-based interventions that differ in their potential for scalability, addressing the need for innovative yet evidence-based brief interventions to improve the health and survival of alcohol dependent HIV patients.