Alcohol Use & HIV: Developing Computerized Interventions

描述(由申请人提供)：酒精使用和危险饮酒对艾滋病毒阳性患者的临床管理和健康结果具有重大影响。艾滋病毒阳性患者饮酒被认为与发病率和死亡率增加、疾病进展更快、对抗逆转录病毒疗法的依从性更差以及病毒耐药性风险更大有关。尽管有这种风险，艾滋病毒提供者并没有准确地识别酒精使用和危险饮酒。这项发展中的R21提案的长期目标是改进艾滋病毒临床环境中危险饮酒的检测和管理，从而减少长期的健康和经济后果。实现这一目标的一(1)种方法是通过短暂干预(BIS)。BIS是一种简单的治疗方法，从简短的建议到简短的励志访谈，说服饮酒者将酒精摄入量减少到低风险水平，从而减少医疗并发症和资源使用。计算机技术提供了一种在医疗保健环境中提供BI的有前景且未被研究的方法。 这一应用程序将结合BIS和最先进的计算机技术，根据临床指南提供针对患者的建议。这一发展项目的具体目标是： 1)采用迭代、定性的用户测试、焦点小组和与提供者和艾滋病毒阳性患者面谈的过程，调整和测试计算机酒精筛查和BL原型(“原型”)； 2)测试实施原型的可行性，评估酒精筛查和干预的潜在障碍(例如，药物治疗方案的复杂性、社会问题等)。并收集退伍军人事务部两个艾滋病毒诊所的入学率数据； 3)测试干预是否与BI后90天内筛查出危险饮酒呈阳性的HIV阳性患者减少饮酒有关。这一探索性/发展性建议将产生一项经过现场测试的干预措施，并对随机临床试验所需的样本大小、招募速度和地点数量进行可靠的估计。

DESCRIPTION (provided by applicant): Alcohol use and hazardous drinking have significant implications for the clinical management and health outcomes of HIV positive patients. Alcohol use in HIV positive patients is believed to be associated with increased morbidity and mortality, more rapid disease progression, poorer adherence to antiretroviral regimens, and greater risk of viral resistance. Despite this risk, HIV providers do not accurately identify alcohol use and hazardous drinking. The long-term objective of this developmental R21 proposal is to improve the detection and management of hazardous drinking in HIV clinical settings, thereby reducing long term health and economic consequences. One (1) method to achieve this objective is through brief interventions (BIs). BIs are simple treatments that vary from brief advice to a short motivational interview and persuade drinkers to reduce their alcohol intake to low risk levels and consequently reduce medical complications and resource use. Computer technology offers a promising and understudied method of delivering Bis in the healthcare setting. This application will combine Bis with state-of-the-art computer technology to deliver patient-specific recommendations based on clinical guidelines. The specific aims of this developmental project are: 1) To adapt and test a computer alcohol screening and Bl prototype ("the prototype") using an iterative, qualitative process of user testing, focus groups, and face-to-face interviews with providers and HIV positive patients; 2) To test the feasibility of implementing the prototype, assess potential barriers to alcohol screening and intervention (e.g., complexity of medication regimen, social issues, etc.) and gather data on enrollment rates in two Department of Veterans Affairs HIV clinics; 3) To test whether the intervention is associated with a decrease in alcohol consumption 90 days post-BI in HIV positive patients who screen positive for hazardous drinking. This exploratory/developmental proposal will produce a field-tested intervention and dependable estimates for sample size, recruitment rate, and number of sites needed for a randomized clinical trial.