Using Ecologic Momentary Assessment to Define Alcohol's Impact on HIV Outcomes

描述（由申请人提供）：艾滋病毒发病率10年来没有下降，预期寿命继续落后于未感染者，尽管艾滋病毒护理取得了巨大进展，包括抗逆转录病毒联合疗法（cART）的有效性和可得性有了重大改善。药物依从性是预防艾滋病毒传播和进展的关键，但在美国，只有28%的艾滋病毒/艾滋病感染者（PLWHA）定期使用所需药物。虽然有许多因素与较低的药物依从性有关，但最重要的障碍之一是酒精的使用。一些研究表明，使用酒精不仅降低了药物依从性，而且还增加了通过无保护和计划外性行为以及非法药物使用传播艾滋病毒的风险。由于流行率如此之高，减少酒精使用以增加药物依从性对于降低艾滋病毒传播和进展至关重要。以前的研究缺乏关于一个人一天之内和一天之间随时间的酒精使用的细节。如果没有这些消费模式和cART依从性，我们就无法有效地向患者提供有关酒精使用及其对依从性和病毒学结果的影响的咨询。我们的总体目标是更好地了解对艾滋病病毒携带者有害的一天内和一天之间的酒精使用模式，以便更好地为今后减少酒精使用和增加药物依从性的干预措施提供信息。每日日记和生态瞬间评估（EMA）研究提供了一个独特的机会来检查实时行为参与及其预测因素和后果，同时利用自然条件和最小化回忆偏差。本研究旨在确定模式的关键细节

DESCRIPTION (provided by applicant): Incidence of HIV has not decreased in 10 years and life expectancy continues to lag behind those who are uninfected despite tremendous advances in HIV care, including major improvements in effectiveness and availability of combination antiretroviral therapies (cART). Medication adherence is key to preventing HIV transmission and progression, yet only 28% of people living with HIV/AIDS (PLWHA) in the U.S. are using required medication routinely. While there are many factors that are associated with lower medication adherence, one of the most important barriers is alcohol use. Several studies have shown that alcohol use not only reduced medication adherence but also increased HIV transmission risk by unprotected and unplanned sex, and illicit drug use. With such high prevalence rates, reducing alcohol use to increase medication adherence is critical to lowering HIV transmission and progression. Previous studies lack details about an individual's intra- and inter-day alcohol use over time. Without those patterns of consumption and cART adherence, we are limited in our ability to effectively counsel patients about alcohol use and its effects on adherence and virologic outcomes. Our overall goal is to better understand the intra- and inter-day patterns of alcohol use that are detrimental to PLWHA in order to better inform future interventions to reduce alcohol use and increase medication adherence. Daily diary and ecological momentary assessment (EMA) studies provide a unique opportunity to examine in real time behavioral engagement and its predictors and consequences while utilizing naturalistic conditions and minimizing recall bias. This study aims to identify the critical details on patterns of use (type of alcohol, size of serving, number of servings, time of day, duration of use, and location consumed) that may enhance the design and effectiveness of future interventions aimed at reducing alcohol use and in turn, slowing HIV progression and reducing HIV transmission risk by improving cART adherence. The daily measurement of alcohol consumption, mood, and cART adherence has not been linked previously. With the rapidly growing population of smart phone owners, we propose that this technology offers a unique opportunity to better understand crucial aspects of detailed alcohol use patterns particularly related to daily medication adherence and pinpoint detrimental alcohol use patterns that will help inform intervention development for more effective real-world interventions aimed at reducing alcohol use and thereby transmission rates and slowing HIV progression. Specifically, our study aims to 1) collect detailed patterns of alcohol use based on: time of day when consumption begins, length of consumption, number of drinks consumed, type of alcohol, and location where consumption occurs, and 2) characterize the effect of detailed alcohol consumption on daily medication adherence among PLWHA (as measured by cART adherence, HIV viral load, CD4 cell count, liver functions). We hypothesize that certain patterns of alcohol consumption serve as determinants of poor health outcomes among PLHWA, through their impact on cART adherence patterns.