Mechanisms of Behavior Change Resource Core for Alcohol-HIV Interventions

描述（由申请人提供）：目前正在通过NIAAA支持的艾滋病毒/艾滋病和酒精相关结局研究试验（CHAART）联盟进行减少艾滋病毒感染者（PLWH）和艾滋病毒感染高危人群重度饮酒的临床试验。本提案的总体目标是最大限度地利用从这些试验中收集的信息，以便更好地设计基于证据的酒精-艾滋病毒咨询干预措施。虽然从动机访谈文献中了解了很多关于酒精和其他物质使用咨询方法中行为改变机制的信息，但对关注性风险行为或药物依从性的干预措施中的改变机制知之甚少，并且缺乏关于多种行为改变机制的工作。为了解决这一差距，我们将在布朗大学酒精研究中心创建一个行为改变资源核心机制（MBCRC），该机制将使用两种不同的编码系统在五个正在进行的CHAART试验中编码提供者-患者对话。具体来说，我们将调整动机访谈技能代码编码酒精和艾滋病毒相关的提供者和患者的语言在酒精艾滋病毒干预措施，并应用广义医学互动分析系统，以检查影响酒精艾滋病毒干预结果的因素以外的动机为重点的行为改变咨询。总的来说，MBCRC将转录和编码提供者-患者互动约1,000 20-90分钟的干预会议从四个正在进行的随机临床试验和一个实施研究。编码数据将用于预测未来的酒精使用，接受和使用酒精药物治疗，高风险性行为，HAART依从性和HIV检测。研究结果将提供有关提供者行为和技能的重要见解，这些行为和技能在促进已确定的高风险人群中饮酒和艾滋病毒相关行为的改变方面最为有效，同时也是改变的主要障碍。结果将直接关系到（a）与艾滋病毒患者和艾滋病毒感染高危人群打交道的培训提供者，以及（B）在各种情况和人群中改进和实施酒精与艾滋病毒的干预措施。 公共卫生相关性：本研究的目的是了解更多关于提供者和患者语言的种类，预测行为改变后咨询酗酒和艾滋病毒相关的行为，如艾滋病毒药物依从性和高风险性行为。结果可以告知提供者与患者沟通对艾滋病毒流行有重要影响的多种行为的最有效方法。

DESCRIPTION (provided by applicant): Clinical trials to reduce heavy alcohol use in people living with HIV (PLWH) and those at high risk for HIV infection are currently being conducted through NIAAA-supported Consortia for HIV/AIDS and Alcohol-Related Outcomes Research Trials (CHAARTs). The overall objective of this proposal is to maximize the information gleaned from these trials to enable better design of evidence-based alcohol-HIV counseling interventions. While a good deal is known from the Motivational Interviewing literature about mechanisms of behavior change in counseling approaches for alcohol and other substance use, little is known about change mechanisms in interventions that focus on sexual risk behaviors or medication adherence, and there is a dearth of work on mechanisms of multiple behavior change. To address this gap, we will create a Mechanisms of Behavior Change Resource Core (MBCRC) within the Brown University Alcohol Research Center on HIV that will code provider-patient dialogues in five ongoing CHAART trials using two distinct coding systems. Specifically, we will adapt the Motivational Interviewing Skills Code to code both alcohol and HIV-relevant provider and patient language in alcohol-HIV interventions and apply the Generalized Medical Interaction Analysis System to examine factors that influence outcomes in alcohol-HIV interventions outside of motivationally-focused behavior change counseling. Overall, the MBCRC will transcribe and code provider-patient interactions across approximately 1,000 20-90, minute intervention sessions from four ongoing randomized clinical trials and one implementation study. Coding data will be used to predict future alcohol use, acceptance and use of alcohol pharmacotherapy, high-risk sex, HAART adherence, and HIV testing. Results will provide crucial insights about provider behaviors and skills that are most effective in fostering changes in drinking and HIV-relevant behaviors in identified high-risk populations, as well as key barriers to change. Results will have direct relevance (a) for training providers who work with HIV patients and those at high risk for HIV infection and (b) for the improvement and implementation of alcohol-HIV interventions in a range of contexts and populations. PUBLIC HEALTH RELEVANCE: The purpose of the present study is to learn more about the kinds of provider and patient language that predict behavior change following counseling on heavy alcohol use and HIV-relevant behaviors such as HIV medication adherence and high-risk sex. Results can inform providers about the most effective methods for communicating with patients about multiple behaviors that have an important impact on the HIV epidemic.