Comparing the effectiveness of two alcohol+adherence interventions for HIV+ youth

描述（由申请人提供）：艾滋病毒感染者使用酒精会加剧健康问题，加速艾滋病毒疾病的进展。抗逆转录病毒疗法（ART）是艾滋病毒感染者最重要的治疗方法。然而，艾滋病毒感染的青少年和年轻成年人（以下称为“青年”）坚持抗逆转录病毒治疗的情况并不理想，这一年龄组的艾滋病毒感染率增长最快，而且有很大的风险从事危险行为，如饮酒。拟议的研究将比较基于家庭与基于诊所的“健康选择”的有效性，这是一种使用动机增强疗法（MET）的简短的4次干预，使用重复测量设计来解决青年艾滋病毒感染者（YLH）的酒精使用，药物依从性和健康结果。与以前的试验不同，健康的选择将在“真实的世界”的临床环境中进行测试，并由社区卫生工作者（CHW）提供，他们已经是艾滋病毒护理团队的成员。研究人群将包括年龄16 - 24岁的YLH，他们是5个ATN研究中心的当前患者。研究中心工作人员将在诊所或通过电话招募潜在参与者。青少年将随机接受健康选择，4次MET治疗YLH，在两种情况下均由相同的CHW在诊所或家庭提供。在基线、4个月（干预后立即）、7个月（干预后3个月）和13个月（干预后9个月）测量结果。生物学测量的数据收集将通过病历提取进行，自我报告的测量将在每个研究中心的iPad上使用简短的基于网络的CASI（计算机管理的自我访谈）调查进行。所有干预会议都将进行录音，用于MITI保真度编码，研究者将在积极干预阶段支持当地主管。我们将在试验结束时与CHW、主管和组织领导进行定性访谈，以获得有关实施障碍和促进因素的关键信息。因此，拟议的试验将使我们能够使用1型主动性-实施混合设计，在现实世界的青少年护理环境中试行可持续的MI实施模式，以实现以下目标：1）检查CHW在现实世界的青少年HIV护理环境中提供有效行为干预的有效性、成本效益和可扩展性; 2）收集有关谁在什么情况下做出反应的信息;（3）加深对未来实施的障碍和促进因素的理解。

DESCRIPTION (provided by applicant): Alcohol use among persons with HIV exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) is the single most important treatment for people living with HIV. However, ART adherence is suboptimal among adolescents and young adults living with HIV (hereafter called "youth"), the age group with the fastest growing rates of HIV infection, and great risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical setting and be delivered by community health workers (CHW), who are already members of the HIV care team. The study population will consist of YLH, ages 16 to 24, who are current patients at 5 ATN sites. Site staff will recruit potential participants in clinic or by telephone. Youth will be randomized to receive Healthy Choices, 4-sessions of MET for YLH, either clinic-based or home-based delivered by the same CHW in both conditions. Outcomes are measured at baseline, 4 months (immediately post-intervention), 7 months (3 months post-intervention) and 13 months (9 months post-intervention). Data collection for biological measures will be conducted through medical record extraction, and self-reported measures will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on an iPad at each site. All intervention sessions will be audio-recorded for MITI fidelity coding, and investigators will support local supervisors during the active intervention phase. We will conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of the trial to obtain critical information about barriers and facilitators of implementation. Thus, the proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to pilot a sustainable model of MI implementation in real-world youth care settings towards the goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care settings; 2) gathering information about who responds under what contexts; and 3) increasing our understanding of the barriers and facilitators for future implementation.