Addressing alcohol misuse in HIV prevention and care: The Brown University Alcohol Research Center on HIV (ARCH)

整体项目总结 酗酒对国内和全球艾滋病毒流行的深度和广度都有影响，途径是 多种途径--增加性行为风险，减少对抗逆转录病毒治疗的依从性，以及 增加艾滋病毒相关合并症和死亡率的风险。为减少艾滋病毒的发病率，方法 必须在艾滋病毒检测和行为测试的背景下，同时解决酒精滥用问题 生物医学预防方法。同样，提高艾滋病毒抑制率，减少与艾滋病毒有关的 在不同的人群中，必须有效地解决酒精滥用的并存问题 护理设置。布朗大学酒精研究中心(ARCH)一直在支持 合作研究，以开发可扩展的酒精-艾滋病毒干预措施，包括视频咨询、远程医疗、 和支持Web的应用程序，这些应用程序可以使用集中的人员和 技术资源。这项更新棕色拱门的申请是围绕以下中心主题组织的 为了实现对人群的影响，在艾滋病毒预防和护理中解决酗酒问题的干预措施 需要以现实世界的有效性、可扩展性和可持续性为重点进行评估， 实施科学的原则。具体地说，我们提出了三个项目，利用我们独特的 (A)在酒精滥用干预方面培训专业人员，(B)利用视频咨询和 远程保健作为接触人群和提供持续护理的可扩展手段，以及(C)利用行为 提供酒精干预和持续支持变革的干预技术。研究 构成部分1(MPI：Wray和Monti)扩展了我们关于酒精在艾滋病毒传播中的作用的工作，包括 通过测试基于网络的干预措施的有效性来测试与男性发生性关系的男性(MSM) 在完成HIV自我检测的MSM中，酒精使用和性行为风险都存在。研究组成部分2(PI：Kahler)扩展 我们在行为远程健康干预方面的工作，通过测试我们的 以前在不同样本的HIV患者中开发的视频咨询和短信干预 在四个获得联邦政府资格的大型城市医疗中心提供医疗服务。研究组件1和组件2共享混合类型 1有效性-实施试验设计，在收集数据的同时提供有关现实世界有效性的数据 与执行有关，以便为今后的研究提供信息。研究部分3(MPI：Becker和Kuo) 通过进行实施试验来评估级联培训模式以补充这些项目 在南非的艾滋病毒护理环境中推广酒精筛查和短暂干预。加在一起，这些 项目-由行政核心、研究方法核心和项目咨询委员会提供支持 并辅之以酒精-艾滋病毒研究方面的杰出培训计划和强大的试点资金 机会-将在转化关于酒精和艾滋病毒的基本和应用知识方面产生重大影响 转变为可推广的方法，以减少酒精滥用对艾滋病毒预防和护理的负面影响。

Overall Project Summary Alcohol misuse impacts the depth and breadth of the HIV epidemic, both domestically and globally, through multiple pathways—increasing sexual risk behaviors, reducing adherence to antiretroviral therapy, and increasing the risk for HIV-associated comorbidities and mortality. To reduce the incidence of HIV, approaches must be developed that concurrently address alcohol misuse in the context of HIV testing and behavioral and biomedical prevention approaches. Likewise, to increase rates of HIV viral suppression and reduce HIV-related comorbidities, alcohol misuse must be addressed effectively in diverse populations across a spectrum of HIV care settings. The Brown University Alcohol Research Center on HIV (ARCH) has been supporting collaborative research to develop scalable alcohol-HIV interventions, including video counseling, telehealth, and web-enabled applications, that can be delivered broadly and efficiently using centralized personnel and technological resources. This application to renew the Brown ARCH is organized around the central theme that in order to achieve population impact, interventions addressing alcohol misuse in HIV prevention and care need to be evaluated with an emphasis on real-world effectiveness, scalability, and sustainability, according to the principles of implementation science. Specifically, we propose three projects that leverage our unique strengths in (a) training professionals in alcohol misuse interventions, (b) utilizing video counseling and telehealth as scalable means of reaching populations and providing continuing care, and (c) utilizing behavioral intervention technologies to provide alcohol interventions and ongoing support for change. Research Component 1 (MPI: Wray and Monti) extends our work on the role of alcohol use in HIV transmission among men who have sex with men (MSM) by testing the effectiveness of a web-based intervention that addresses both alcohol use and sex risk in MSM completing HIV self-testing. Research Component 2 (PI: Kahler) extends our work on behavioral telehealth interventions to reduce alcohol misuse in HIV-infected MSM by testing our previously developed video counseling and text messaging interventions in a diverse sample of patients in HIV care at four large, urban federally-qualified health centers. Research Components 1 and 2 share a Hybrid Type 1 effectiveness-implementation trial design, providing data on real-world effectiveness while gathering data related to implementation to inform future studies. Research Component 3 (MPI: Becker and Kuo) complements these projects by conducting an implementation trial that evaluates a cascading training model to promote alcohol screening and brief intervention across HIV care settings in South Africa. Together, these projects—supported by an Administrative Core, Research Methods Core, and Program Advisory Committee and complemented by an outstanding training program in alcohol-HIV research with robust pilot funding opportunities—will make a substantial impact in translating basic and applied knowledge on alcohol and HIV into scalable approaches to reducing the negative impact of alcohol misuse on HIV prevention and care.