SUPPORTING ALCOHOL REDUCTION IN HIV+ PATIENTS: A TRAINING FOR HIV CARE PROVIDERS

描述（由申请人提供）：本申请旨在为艾滋病护理提供者开发和评估一个理论驱动的培训，以支持他们系统地使用国家酒精滥用和酒精中毒研究所的有效简短干预（NIAAA’s Bl）来减少酒精。艾滋病毒和艾滋病毒/丙型肝炎合并感染的高危人群酒精使用率很高，这种酒精使用往往造成以下严重危害：(a)加速疾病进展，(b)限制抗逆转录病毒治疗的有效性和可及性，以及(c)有时增加严重危害其及其伴侣健康的危险性行为，这为开展这项研究提供了理由和紧迫性。尽管作为“积极预防”的一部分，提供者在筛查和建议患者减少酒精方面处于独特的地位，但他们很少这样做，通常是由于经验、技能和自我效能有限。因此，对提供者进行培训以实施NIAAA的Bl是非常必要的，而且，正如我们的初步研究表明的那样，艾滋病毒护理提供者对接受这样的培训很感兴趣，并表示他们会将所学到的Bl技能付诸实践。因此，在社会认知理论和辛普森组织变革模型的指导下，拟议的发展研究的目的是(1)创建一个最先进的提供者培训，通过教授参与者(a)如何筛查患者的酒精使用，以及(b)如何有效地建议他们使用动机性访谈原则来减少这种使用，从而鼓励NIAAA的Bl的实施；(2)在纽约市的4个指定艾滋病中心实施培训，以获得培训对提供者培训后立即、培训后1个月和4个月的知识、态度、自我效能、集体组织效能和实际使用NIAAA的Bl的影响的初步数据；(3)获取初步数据，以检验提供者培训对(a)患者减少饮酒的影响；(b)艾滋病毒提供者组织，就(i)处理酒精和艾滋病毒及艾滋病毒/丙型肝炎病毒合并感染的组织气氛；㈡本组织实际扩大现有减少酒精消费服务和（或）实施减少酒精消费新服务的情况。如果结果表明，培训是有用的、可行的、可接受的，并有效地填补了艾滋病毒患者的关键服务空白，我们将寻求资金，以进一步检查其在各种场所的有效性，并广泛传播培训。

DESCRIPTION (provided by applicant): This application aims to develop and evaluate a theory-driven training for HIV care providers to support their systematic use of the National institute on Alcohol Abuse and Alcoholism's effective brief intervention (NIAAA's Bl) for alcohol reduction. The high rate of at-risk alcohol use among individuals with HIV and HIV/HCV co-infection, and the serious harm that such alcohol use often causes in (a) accelerating disease progression, (b) limiting effectiveness and access to ARV therapy, and (c) sometimes increasing risky sexual behaviors that seriously jeopardize their health and that of their partners, provides the rationale and urgency for this research. Although providers are uniquely positioned to screen and counsel patients about alcohol reduction as part of a "prevention with positive" focus, they rarely do, often as a result of limited experience, skills, and self-efficacy. Thus, a provider training to implement NIAAA's Bl is critically needed, and, as our preliminary studies indicate, HIV care providers are interested in receiving such a training and indicate they would put the Bl skills they learn into practice. Thus, guided by Social Cognitive Theory and Simpson's Model of Organizational Change, the aims of the proposed developmental study are to (1) create a state-of-the-art provider training to encourage the implementation of NIAAA's Bl by teaching participants (a) how to screen patients for alcohol use, and (b) how to effectively counsel them to reduce this use using the principles of motivational interviewing; (2) to implement the training in 4 Designated AIDS Centers in New York City to obtain preliminary data regarding the impact of the training on providers immediately post-training, and 1- and 4- months post- training with regard to their knowledge, attitudes, self-efficacy, collective organizational efficacy, and actual use of NIAAA's Bl; and (3) to obtain preliminary data in order to examine the impact of the provider training on (a) patients' alcohol reduction; and on (b) the HIV provider organization, in terms of (i) the organizational climate towards dealing with alcohol and HIV and HIV/HCV co-infection; and (ii) the organization's actual expansion of existing alcohol reduction services and/or the implementation of new services to reduce alcohol consumption. If results demonstrate that the training is useful, feasible, acceptable, and effective in filling a critical service gap for HIV patients, we will seek funding to further examine its effectiveness in a variety of venues and to disseminate the training widely.