Mechanisms of Behavior Change Resource Core for Alcohol-HIV Interventions

描述(由申请人提供)：减少艾滋病毒携带者(PLWH)和艾滋病毒感染高危人群使用大量酒精的临床试验目前正在通过NIAAA支持的艾滋病毒/艾滋病和酒精相关结果研究试验(CHAART)联盟进行。这项建议的总体目标是最大限度地利用从这些试验中收集到的信息，以便更好地设计基于证据的酒精-艾滋病毒咨询干预措施。虽然关于酒精和其他物质使用咨询方法中行为改变机制的激励性采访文献很多，但对专注于性危险行为或服药依从性的干预措施中的行为改变机制知之甚少，关于多重行为改变机制的工作也很少。为了弥补这一差距，我们将在布朗大学艾滋病毒酒精研究中心内创建一个行为改变资源核心机制(MBCRC)，它将使用两种不同的编码系统对正在进行的五项CHAART试验中的提供者-患者对话进行编码。具体地说，我们将修改激励访谈技能代码，以编码酒精和艾滋病毒相关提供者和患者在酒精-艾滋病毒干预中的语言，并应用通用医疗互动分析系统来检查除以动机为重点的行为改变咨询之外，影响酒精-艾滋病毒干预结果的因素。总体而言，MBCRC将转录和编码提供者-患者之间的互动，跨越大约1,000个20-90分钟的干预会议，来自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、酒精药物治疗的接受和使用、高危性行为、HAART依从性和艾滋病毒检测。结果将提供关于提供者行为和技能的关键见解，这些行为和技能最有效地促进已确定的高危人群中饮酒和艾滋病毒相关行为的改变，以及改变的关键障碍。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合作的培训提供者，以及(B)在各种背景和人群中改进和实施酒精-艾滋病毒干预措施。

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.