HealthCall: Enhancing brief intervention for HIV primary care alcohol dependence

描述（由申请人提供）：在艾滋病毒感染者中，大量饮酒预示着抗逆转录病毒治疗（ART）依从性差，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，以改善重度饮酒艾滋病毒患者的健康和生存。对非依赖性普通初级保健患者进行简短的饮酒干预是有效的，但酒精依赖患者需要更广泛的干预。对艾滋病毒感染者采取经过检验的减少饮酒干预措施需要大量的人员时间。为了在不增加工作人员时间的情况下扩大艾滋病毒诊所的简短干预，我们利用通信技术开发了HealthCall，这是一种针对城市艾滋病毒患者的简短饮酒减少干预的创新增强。健康呼叫使用技术让患者在60天内对饮酒、ART依从性和其他健康行为进行简短的日常自我监测。然后总结患者的自我监测数据，在30天和60天提供个性化反馈，供简要回顾和讨论。患者对HealthCall的满意度很高。重要的是，在城市酒精依赖的HIV初级保健患者中，我们表明，当与简短的动机访谈（MI; MI+HealthCall）配对时，HealthCall可有效减少大量饮酒。从那时起，形成性工作也指出了如何增加HealthCall对抗逆转录病毒疗法（ART）依从性的关注。MI是理论驱动的，以证据为基础的，有效的，但需要认真的培训，监督和技能的成功结果。将HealthCall与更可扩展的简短干预相结合，将提供更广泛的公共卫生益处。NIAAA建议临床医生指南（CG）作为一个简短的，以证据为基础的方法，酒精干预的卫生保健人员谁没有咨询背景。与MI相比，CG需要更少的培训和特定技能，因此与HealthCall配对时可能会降低成本并提高可扩展性。CG也可以很容易地将注意力纳入ART依从性。我们提出了一项随机试验，比较MI+HealthCall，CG+HealthCall和CG-仅在300名英语或西班牙语的酒精依赖的HIV患者在三个不同的城市HIV诊所。主要结果是减少饮酒。重要的次要结果是ART依从性、病毒载量、HIV护理的保留、吸烟和每种干预措施的相对成本。我们还将探讨治疗是否 对饮酒的影响受场所或患者特征的调节，并由基于理论的机制（承诺改变;自我效能）介导。将通过12个月随访评估效应的持久性。我们的科学团队在酒精，ART坚持，基于技术的简短干预和成本分析方面具有专业知识，因此能够成功进行研究。响应PA-13-121，本研究将提供有关HealthCall与两种简短的循证干预措施配对时减少HIV酒精依赖患者饮酒的有效性的信息，这两种干预措施在可扩展性方面的潜力不同，解决了对创新但基于证据的简短干预措施的需求，以改善酒精依赖HIV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.