Comparing the effectiveness of two alcohol+adherence interventions for HIV+ youth

描述（由申请人提供）：艾滋病毒感染者使用酒精会加剧健康问题并加速艾滋病毒疾病的进展。抗逆转录病毒疗法（ART）是对艾滋病毒感染者最重要的治疗方法。然而，在感染艾滋病毒的青少年和青壮年（以下称为“青年”）中，坚持抗逆转录病毒治疗的情况并不理想，这是艾滋病毒感染率增长最快的年龄组，而且从事诸如饮酒等危险行为的风险很大。拟议的研究将比较基于家庭和基于诊所的“健康选择”的有效性，这是一种使用动机增强疗法（MET）的简短的4次干预，使用重复测量设计来解决青少年艾滋病毒感染者（YLH）的酒精使用、药物依从性和健康结果。与以前的试验不同，健康选择将在“真实世界”的临床环境中进行测试，并由社区卫生工作者（CHW）提供，他们已经是艾滋病毒护理小组的成员。研究人群将包括16至24岁的YLH，他们是5个ATN站点的当前患者。现场工作人员将在诊所或电话中招募潜在的参与者。青少年将被随机分配接受健康选择，四期的MET，在两种情况下由同一健康中心在诊所或家庭提供。在基线、4个月（干预后立即）、7个月（干预后3个月）和13个月（干预后9个月）测量结果。生物测量的数据收集将通过医疗记录提取进行，自我报告的测量将在每个站点使用iPad进行简短的基于网络的CASI（计算机管理的自我访谈）调查。所有的干预会议都将被MITI保真编码录音，调查人员将在积极干预阶段为当地主管提供支持。在试验结束时，我们将与卫生工作者、主管和组织领导人进行定性访谈，以获得有关实施障碍和促进因素的关键信息。因此，拟议的试验将允许我们使用1型有效性-实施混合设计来试点在现实世界的青少年护理环境中实施MI的可持续模式，以实现以下目标：1)检查在现实世界的青少年艾滋病毒护理环境中由卫生工作者提供的有效行为干预的有效性、成本效益和可扩展性；2)收集关于谁在什么情况下做出回应的信息；3)增加我们对未来实施的障碍和促进因素的理解。

DESCRIPTION (provided by applicant): Alcohol use among persons with HIV exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) is the single most important treatment for people living with HIV. However, ART adherence is suboptimal among adolescents and young adults living with HIV (hereafter called "youth"), the age group with the fastest growing rates of HIV infection, and great risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical setting and be delivered by community health workers (CHW), who are already members of the HIV care team. The study population will consist of YLH, ages 16 to 24, who are current patients at 5 ATN sites. Site staff will recruit potential participants in clinic or by telephone. Youth will be randomized to receive Healthy Choices, 4-sessions of MET for YLH, either clinic-based or home-based delivered by the same CHW in both conditions. Outcomes are measured at baseline, 4 months (immediately post-intervention), 7 months (3 months post-intervention) and 13 months (9 months post-intervention). Data collection for biological measures will be conducted through medical record extraction, and self-reported measures will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on an iPad at each site. All intervention sessions will be audio-recorded for MITI fidelity coding, and investigators will support local supervisors during the active intervention phase. We will conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of the trial to obtain critical information about barriers and facilitators of implementation. Thus, the proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to pilot a sustainable model of MI implementation in real-world youth care settings towards the goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care settings; 2) gathering information about who responds under what contexts; and 3) increasing our understanding of the barriers and facilitators for future implementation.