Cell Phone Technology Targeting ART and Naltrexone Adherence and Alcohol Use

描述(由申请人提供)：当前研究的目标是通过创新的短信策略加强纳曲酮药物治疗，以提高复发预防技能，减少艾滋病毒危险行为，并改善纳曲酮和艾滋病毒治疗方案的依从性，从而改善对酒精依赖成年人的治疗。本申请是对PA-10-013“行为和综合治疗发展计划”的响应，该计划鼓励“对利用各种技术以提高疗效和/或增加社区友好性的循证治疗干预措施的研究；对补充和/或增强药物疗效的行为治疗的研究；对……与药物滥用共存的医疗条件的治疗干预研究；以及在药物滥用治疗的背景下开发与治疗、坚持和艾滋病毒预防相关的方法和技术的研究。”与PA声明的这些目标一致，这项研究的具体目标是：1)根据用户反馈，开发和完善基于认知行为疗法的短信干预(TXT-CBT)，以加强对患有酒精使用障碍的HIV感染成年人的酒精依赖的药物治疗；2)进行一项试点随机临床试验，以评估 招募和留住个人进行大规模研究，并确定TXT-CBT对酒精使用、HIV用药依从性、纳曲酮依从性和医疗结果的影响大小。MM和MM+TXT-CBT参与者将在基线、治疗结束和治疗后12周进行评估；3)检查TXT-CBT的潜在作用机制，包括自我效能、应对技能和社会支持。我们假设，与MM单独使用相比，TXT-CBT与MM联合使用将更大程度地减少酒精使用和艾滋病毒危险行为，并将改善纳曲酮和HIV治疗方案的依从性。此外，我们预计MM+TXT-CBT将促进自我效能、应对技能和社会支持方面的更大变化，并且这些变化将与物质使用结果相关。将收集有关成本效益的初步数据，以开始评估与这种以技术为基础的干预措施相关的成本节约。TXT-CBT结合了特定的物质和依从性认知治疗技术，同时强调减少艾滋病毒危险行为。通过为最大限度地遵守艾滋病毒治疗方案提供支持，再加上防止酒精复发的应对技能，TXT-CBT可能为感染艾滋病毒的酒精使用者的治疗提供一种前景光明、成本效益高且易于部署的增强策略。

DESCRIPTION (provided by applicant): The objective of the current research is to improve treatment for alcohol dependent adults by augmenting naltrexone pharmacotherapy with an innovative text-messaging strategy to promote relapse prevention skills, reduce HIV-risk behaviors, and improve naltrexone and HIV treatment regimen adherence. This application is in response to PA-10-013, "Behavioral & Integrative Treatment Development Program," which encourages "Studies on evidence-based treatment interventions that utilize various technologies in order to increase efficacy and/or increase community-friendliness; Research on behavioral treatments that complement and/or potentiate the effects of medications; Research on treatment interventions for...medical conditions that are co- occurring with substance abuse; and research on the development of methods and technologies relevant to treatment, adherence, and HIV prevention within the context of drug abuse treatment." Consistent with these stated objectives of the PA, the specific aims of this research are 1) To develop and refine, with user feedback, a cognitive behavioral therapy-based text-messaging intervention (TXT-CBT) to augment pharmacotherapy for alcohol dependence in HIV-infected adults with alcohol use disorders; 2) To conduct a pilot randomized clinical trial to assess the feasibility of recruiting and retaining individuals for a large scale study and to determine the effect size of TXT-CBT over and above medication management with naltrexone (MM) on alcohol use, HIV medication adherence, naltrexone adherence, and healthcare outcomes. Both MM and MM+TXT-CBT participants will be assessed at baseline, treatment-end, and 12 weeks post-treatment; and 3) To examine potential mechanisms of action of TXT-CBT, including self-efficacy, coping skills, and social support. We hypothesize that TXT-CBT delivered in conjunction with MM will produce greater reductions in alcohol use and HIV-risk behaviors, and will improve naltrexone and HIV treatment regimen adherence, relative to MM alone. Further, we expect that MM+TXT-CBT will facilitate greater changes in, self-efficacy, coping skills, and social support, and these changes will be associated with substance use outcomes. Preliminary data concerning cost-effectiveness will be gathered to begin to evaluate the cost savings associated with this technology-based intervention. TXT-CBT incorporates specific substance- and adherence-focused cognitive therapy techniques with a concurrent emphasis on reducing HIV-risk behaviors. By providing support to maximize HIV treatment regimen adherence, coupled with coping skills to prevent alcohol relapse, TXT-CBT may provide a promising, cost-effective, and easily deployable augmenting strategy for the treatment of alcohol users who are HIV- infected.