HealthCall: Brief Intervention to Reduce Drug Use in HIV Primary Care

描述（由申请人提供）：正在进行的艾滋病毒流行越来越多地涉及非注射毒品使用（NIDU）。在艾滋病毒感染者中，特别是弱势群体，如艾滋病毒初级保健中的低收入少数民族患者，减少NIDU对改善整体健康和HAART依从性以及减少艾滋病毒的性传播非常重要。在减少这一复杂人群的非吸毒方面取得进展的一个障碍是缺乏有效的干预措施，对工作人员和资源的需求有限。旨在克服这一障碍的干预措施将动机访谈与自动电话技术（HealthCall）相结合。干预开始于顾问管理针对NIDU的简短MI会话。然后，几乎没有额外的工作人员的时间，"健康呼叫"通过病人使用交互式语音应答（IVR）技术，提供行为自我监测NIDU和其他目标行为扩展干预。患者在60天内每天对IVR进行简短的呼叫。在第30天和第60天，MI顾问与患者会面，并向他们提供简短的个性化反馈，讨论从IVR数据生成的药物使用图表。因此，HealthCall可作为短暂MI的"临床医生扩展器"。在一家大型大城市HIV初级保健诊所中，在低SES、少数民族主动非注射药物使用患者中进行的一项成功的MI + HealthCall随机化初步研究证明了MI + HealthCall的可接受性和可行性，并且与仅MI相比，表明MI + HealthCall在减少药物使用和改善HAART依从性方面的疗效。拟定在相同的背景和患者人群中进行MI + HealthCall的3组随机对照试验（RCT）。在本RCT中，390例患者将被随机分配至（1）MI + HealthCall组、（2）仅MI组或（3）教育对照组。将在基线、30天和60天以及3个月、6个月和12个月时进行评价。主要结果是减少主要药物（非注射可卡因，海洛因或甲基苯丙胺）的使用，提高HAART依从性，减少性风险行为。中介者（改变动机和自我效能）和调节者（例如，抑郁症将被研究。实现研究目标可以帮助减少NIDU，提高HAART依从性并减少HIV初级保健患者的性风险行为。更广泛地说，一种新的、技术增强的干预措施将被添加到治疗文献中，这可能会改变关于所需临床医生时间与患者参与干预持续时间之比的概念。该提案是对NIDA PA-09 - 236 "美国的艾滋病毒/艾滋病、毒品使用和弱势群体"的回应。 公共卫生相关性：在HIV感染者中，非注射吸毒（NIDU）与HIV药物依从性差、HIV/AIDS风险行为增加和非AIDS死亡率增加相关。因此，减少艾滋病毒感染者的NIDU对他们的生存和限制艾滋病毒的传播至关重要。我们建议研究一种技术增强的简短干预措施的有效性，以减少艾滋病毒初级保健患者的NIDU，这对忙碌的医务人员要求不高，并被患者广泛接受。

DESCRIPTION (provided by applicant): The ongoing HIV epidemic increasingly involves non-injection drug use (NIDU). In HIV-infected individuals, particularly vulnerable populations such as low-income minority patients in HIV primary care, reducing NIDU is important to improve overall health and HAART adherence, and to reduce sexual transmission of HIV. A barrier to progress in NIDU reduction for this complex population has been the lack of effective interventions that make limited demands on staff and resources. An intervention designed to overcome this barrier combines Motivational Interviewing (MI) with automated telephone technology (HealthCall). The intervention begins with a counselor administering a brief MI session targeting NIDU. Then, with little additional staff time, "HealthCall" extends the intervention through patient use of Interactive Voice Response (IVR) technology, which provides behavioral self-monitoring of NIDU and other target behaviors. Patients make brief daily calls to the IVR for 60 days. At 30 and 60 days, MI counselors meet with patients and give them brief personalized feedback, discussing a graph on their drug use generated from the IVR data. Thus, HealthCall serves as a "clinician-extender" of the brief MI. A successful randomized pilot study of MI+HealthCall among low-SES, minority patients with active non- injection drug use in a large, metropolitan, HIV primary care clinic demonstrated acceptability and feasibility of MI+HealthCall, and, compared to MI-only, suggested efficacy of MI+HealthCall in reducing drug use and improving HAART adherence. A 3-arm randomized controlled trial (RCT) of MI+HealthCall is proposed in the same setting and patient population. In this RCT, 390 patients will be randomized to (1) MI+HealthCall, (2) MI-only or (3) educational control. Evaluations will be done at baseline, 30 and 60 days, and at 3, 6 and 12 months. Main outcomes are reduction in use of primary drug (non-injection cocaine, heroin or methamphetamine), improved HAART adherence, and reduced sexual risk behavior. Mediators (motivation to change and self-efficacy) and moderators (e.g., depression) will be explored. Achieving study aims could help reduce NIDU, improve HAART adherence and reduce sexual risk behaviors in HIV primary care patients. More broadly, a novel, technologically-enhanced intervention would be added to the treatment literature that could change concepts about the ratio of required clinician time to the duration of patient participation in an intervention. This proposal is responsive to NIDA PA-09-236 "HIV/AIDS, Drug Use, and Vulnerable Populations in the US". PUBLIC HEALTH RELEVANCE: Among HIV-infected individuals, non-injection drug use (NIDU) is associated with poor HIV medication adherence, greater HIV/AIDS risk behaviors, and increasing non-AIDS mortality. Thus, reducing NIDU among HIV-infected individuals is critical to their survival and to limiting the spread of HIV. We propose to study the efficacy of a technologically-enhanced brief intervention to reduce NIDU in HIV primary care patients that demands little from busy medical staff and is well-accepted by patients.