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有重大影响。据信，艾滋病毒阳性患者的酒精使用与发病率和死亡率增加、疾病进展更快、抗逆转录病毒治疗依从性较差以及病毒耐药性风险增加有关。尽管存在这种风险，但艾滋病毒提供者不能准确识别酒精使用和危险饮酒。这一发展性R21提案的长期目标是改善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。实现这一目标的一种方法是通过简短干预（BIs）。BIs是一种简单的治疗方法，从简短的建议到简短的动机性访谈，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环境中提供Bis的有前途且尚未得到充分研究的方法。

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.