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

描述（由申请人提供）：持续的艾滋病毒流行越来越多地涉及非注射吸毒（NIDU）。在艾滋病毒感染者中，特别是弱势群体，如接受艾滋病毒初级保健的低收入少数群体患者，减少非艾滋病毒感染率对于改善总体健康和坚持HAART疗法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NIDU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。一种旨在克服这一障碍的干预措施结合了动机访谈（MI）和自动电话技术（HealthCall）。干预开始于一名顾问针对NIDU进行简短的MI会话。然后，在几乎没有额外工作人员时间的情况下，“HealthCall”通过患者使用交互式语音应答（IVR）技术来扩展干预，该技术提供NIDU和其他目标行为的行为自我监测。患者在60天内每天向IVR拨打简短的电话。在第30天和第60天，心理咨询师与患者会面，给他们简短的个性化反馈，讨论从IVR数据生成的药物使用图表。因此，HealthCall作为简短的MI的“临床-扩展者”。一项成功的随机试验研究表明，MI+HealthCall在低社会经济地位、在大城市的HIV初级保健诊所积极使用非注射药物的少数患者中，证明了MI+HealthCall的可接受性和可行性，并且与仅使用MI相比，表明MI+HealthCall在减少药物使用和提高HAART依从性方面的有效性。建议在相同的环境和患者群体中进行MI+HealthCall的三组随机对照试验（RCT）。在这项随机对照试验中，390名患者将被随机分为(1)心肌梗死+HealthCall组、(2)仅心肌梗死组和(3)教育对照组。评估将在基线、30天和60天以及3个月、6个月和12个月进行。主要结果是减少了主要药物（非注射性可卡因、海洛因或甲基苯丙胺）的使用，改善了HAART疗法的依从性，并减少了性风险行为。将探讨调节因子（改变动机和自我效能）和调节因子（如抑郁）。实现研究目标可以帮助减少NIDU，提高HAART治疗依从性，并减少艾滋病毒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，这可能会改变有关临床医生所需时间与患者参与干预的持续时间之比的概念。该提案响应NIDA PA-09-236“美国的艾滋病毒/艾滋病、药物使用和弱势群体”。

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".