Alcohol & HIV in Kenya: Stage 1 Trial of a Peer-led Alcohol Behavior Intervention

描述(由申请人提供)：在HIV感染者中，酒精使用和滥用与危险的性行为增加、抗逆转录病毒治疗(ARV)的依从性差以及ARV的毒性有关。因此，酒精的使用和滥用对艾滋病毒的传播和疾病的发展具有重大影响。由于酒精滥用在肯尼亚很普遍，据估计，普通内科诊所的危险饮酒比例高达68%，艾滋病毒诊所的危险饮酒比例高达53%，因此我们提出了一项第一阶段试点项目，以开发和评估同行领导的团体认知行为治疗(CBT)，目标是有资格接受抗逆转录病毒治疗的感染艾滋病毒的肯尼亚人使用酒精。虽然CBT非常适合肯尼亚的环境，因为它相对结构化，并与肯尼亚的饮酒行为概念模型一致，但由于肯尼亚心理健康专业人员的供应极其有限，它需要适应同伴分娩。这项为期24个月的能力建设R21研究的目标是评估一种新的CBT应用的有效性，与常规护理支持组相比，CBT是肯尼亚埃尔多雷特的一个由6个疗程的同行领导的小组，用于减少感染艾滋病毒的成年人的危险和酗酒。这项工作将通过肯尼亚-美国艾滋病毒和酒精研究与预防伙伴关系(KHARPP)进行，该伙伴关系是一个经验丰富的团队，由肯尼亚和美国的医生、行为科学家、回收物质使用者和艾滋病毒感染者组成。KHARPP扩展了艾滋病毒/艾滋病预防和治疗学术模型(AMPATH)和退伍军人老龄化队列研究(VICS)之间业已建立的联系，VAS是一项关于艾滋病毒和酒精的纵向临床研究。AMPATH在肯尼亚西部的15家诊所治疗超过25,000名患者。作为这些努力的一部分，我们已经完成了斯瓦希里语的翻译和CBT议定书的改编，翻译了筛查和结果文书，并对当地酿造的饮料的类型和份量进行了量化。我们的具体目标是：1)培训2名肯尼亚心理学家，使用标准化的遵守/质量评级量表对同伴主导的CBT模式提供持续的质量/保真度监测；2)培训4名肯尼亚同伴促进者，进行标准化CBT干预，以减少酒精使用；以及3)通过一项为期6周的小型试验，评估同行领导小组CBT干预的可行性，在该试验中，56名感染艾滋病毒的肯尼亚人被随机分为同性CBT或普通护理HIV支持组。我们的目标与NIAAA减少弱势人群酒精使用和艾滋病毒风险的使命一致，我们的目标的完成将产生以下产品：(1)英语和斯瓦希里语CBT干预的完整手册，(2)临床医生培训材料和流程评价表，(3)试点研究的初步效果大小指标，以及适用于这种环境和人群的调整后的酒精相关评估工具。如果CBT干预在这一阶段1研究中被证明是有希望的，这些材料应该足以在肯尼亚更多的HIV诊所实施针对这一人群的完整的“阶段2”随机试验。这项研究将确定与普通护理支持组相比，认知行为干预是否在肯尼亚有效，该干预在美国证明了减少饮酒的有力证据。它将由感染艾滋病毒的个人提供，他们可能几乎没有接受过正规教育，但接受过标准化干预方法的培训，并敏锐地了解患有艾滋病毒感染和酗酒问题的同龄人的需求。这一方法与在资源匮乏的环境中提供服务的成功的成本效益模式是一致的，在这种环境中，非专业人员(例如，临床干事、传统助产士和同伴辅导员)接受了培训。

DESCRIPTION (provided by applicant): Alcohol use and abuse have been associated with increased risky sexual behavior, poor adherence to antiretroviral therapy (ARVs) and toxicity from ARVs among those with HIV infection. As such, alcohol use and abuse have a major impact on HIV transmission and disease progression. Because alcohol abuse is widespread in Kenya, with estimates of hazardous drinking as high as 68% in general medicine clinics and 53% in HIV clinics, we propose a Stage 1 pilot project to develop and evaluate a peer-led group cognitive behavioral treatment (CBT) targeting alcohol use among HIV infected Kenyans who are eligible for ARV therapy. Although CBT is well-suited to the Kenyan setting because it is comparatively structured and consistent with the Kenyan conceptual model of drinking behavior, it requires adaptation for peer delivery due to the extremely limited supply of Kenyan mental health professionals. The goal of this 24-month capacity- building R21 study is to evaluate the efficacy of a novel application of CBT, a 6-session peer-led group in Eldoret, Kenya, when compared against a usual care support group, to reduce hazardous and binge drinking among adult persons infected with HIV. This work will be conducted via the Kenya-U.S. HIV and Alcohol Research and Prevention Partnership (KHARPP)-an experienced team of Kenyan and U.S. physicians, behavioral scientists, recovered substance users and persons infected with HIV. KHARPP expands on well- established ties between the Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) and the Veterans Aging Cohort Study (VACS), a longitudinal clinical study of HIV and alcohol. AMPATH treats more than 25,000 patients in 15 clinics in western Kenya. As a part of these efforts, we have already completed translation to Kiswahili and adaptation of the CBT protocol, translation of the screening and outcome instruments, and the quantification of types and serving sizes of locally brewed drinks. Our specific aims are to: 1) train 2 Kenyan psychologists to provide ongoing quality/fidelity monitoring of the peer-led CBT model using standardized adherence/quality rating scales; 2) train 4 Kenyan peer facilitators in the standardized CBT intervention to reduce alcohol use; and 3) evaluate the feasibility of the peer-led group CBT intervention via a small, 6-week trial in which 56 HIV infected Kenyans are randomized to same-sex CBT or usual care HIV support groups. Completion of our objectives, which are consistent with NIAAA's mission to reduce both alcohol use and HIV risk in vulnerable populations, will result in the following products: (1) a complete manual for the CBT intervention in both English and Kiswahili, (2) clinician training materials and process rating forms, (3) preliminary indicators of effect size from the pilot study, and well as adapted alcohol-related assessment instruments for this setting and population. If the CBT intervention is demonstrated to have promise in this Stage 1 study, these materials should be sufficient to develop a full "Stage 2" randomized trial with this population to be implemented at additional HIV clinics in Kenya. This study will determine whether a cognitive behavioral intervention that demonstrates strong evidence in the U.S. of reducing alcohol use is effective in Kenya, when compared against a usual care support group. It will be delivered by individuals who are infected with HIV and may have little formal education but who are trained in standardized intervention methods and keenly aware of the needs of their peers with HIV infection and alcohol problems. This approach is consistent with successful cost-effective models of service delivery in resource-poor settings in which lay individuals (e.g., clinical officers, traditional birth attendants and peer counselors) are trained.