Behavioral interventions to reduce heavy drinking in HIV-infected men in primary care.

项目总结 HIV感染者大量饮酒可导致抗逆转录病毒治疗依从性低和病毒学差 控制，更大的性风险，肝脏疾病的风险增加，以及认知功能下降。因此， 减少饮酒可能会对艾滋病毒感染患者产生特别积极和广泛的影响。男人们 男男性行为(MSM)仍然是新感染艾滋病毒的大多数，感染艾滋病毒的MSM 危险饮酒率高达33%。因此，开发和测试干预措施以减少 在感染艾滋病毒的男男性接触者中大量饮酒是一个非常高的公共卫生优先事项。酒精含量相对较少。 针对男男性接触者的干预措施进行了测试，只有两种干预措施解决了感染艾滋病毒的男男性接触者饮酒问题。虽然 最近的研究表明，行为干预可以大大减少艾滋病毒感染患者的大量饮酒 关于不同行为干预方法的有效性以及它们独特的 综合效应。本研究的目的是进行完全交叉的2×2×2因子随机设计 对从2家城市艾滋病毒初级保健诊所招募的224名MSM进行了不同样本的对照试验(其中一家在 东北和南部各有一个)。第一个研究因素将比较简短的建议(BA)和动机 干预(MI)，包含详细的、个性化的、规范性的和针对艾滋病毒的反馈。第二个因素 将交互式短信(ITM)干预与不使用短信进行比较。最后一个因素是比较 低强度和低持续时间的干预(为期一个月的两次会议)到延长干预(EI)，需要5 疗程超过9个月。BA和MI将由一组核心干预者从中央位置提供 使用支持网络摄像头的远程医疗系统，这可以促进更大规模的实施。设计 将允许我们检验这样的假设：MI与BA相比，ITM与非ITM相比，EI与NO相比 EI，将显著减少酒精饮料的消费量和重度酒精饮料的消费量 在6个月和12个月的随访中饮酒天数。次要结果包括接触无保护肛门 性交、ART依从性和病毒抑制、CD4细胞计数、肝功能测试和神经认知 功能。我们还将测试这一假设，即MI、ITM和EI对饮酒的影响将通过以下方式缓和 酒精使用障碍的状态和改变饮酒的准备情况，使这些干预措施将相对 对于那些患有当前障碍和准备程度较低的人，效果更好。这项研究将提供至关重要的 关于哪种干预方法单独或联合使用可能最有效的证据 在艾滋病毒护理环境中大规模实施。

PROJECT SUMMARY Heavy drinking in HIV-infected patients can lead to low antiretroviral therapy adherence and poor virologic control, greater sexual risk taking, increased risk of liver disease, and decreased cognitive function. Therefore, reductions in drinking may have particularly positive and widespread effects in HIV-infected patients. Men who have sex with men (MSM) continue to represent the majority of new HIV infections, and HIV-infected MSM have rates of hazardous drinking as high as 33%. Therefore, developing and testing interventions to reduce heavy drinking in HIV-infected MSM is a very high public health priority. There have been relatively few alcohol interventions tested that focus on MSM, and only two have addressed drinking in HIV-infected MSM. Although recent studies indicate that behavioral interventions can reduce heavy drinking in HIV-infected patients, much remains unknown about the efficacy of different approaches to behavioral intervention and their unique and combined effects. The purpose of the present study is to conduct a fully-crossed 2 X 2 X 2 factorial randomized controlled trial with a diverse sample of 224 MSM recruited from 2 urban HIV primary care clinics (one in the Northeast and one in the South). The first study factor will compare brief advice (BA) vs. a motivation intervention (MI) that contains detailed personalized normative and HIV-specific feedback. The second factor compares an interactive text messaging (ITM) intervention vs. no text messaging. The final factor compares intervention of low intensity and duration (two sessions over 1 month) to extended intervention (EI) entailing 5 sessions over 9 months. BA and MI will be delivered by a core set of interventionists from a central location using a webcam-enabled telemedicine system, which can facilitate larger-scale implementation. The design will allow us to test the hypothesis that MI compared to BA, ITM compared to no ITM, and EI compared to no EI, will result in significantly greater reductions in number of alcoholic drinks consumed and number of heavy drinking days at 6- and 12-month follow-ups. Secondary outcomes include engagement in unprotected anal intercourse, ART adherence and viral suppression, CD4 cell count, liver function tests, and neurocognitive function. We also will test the hypothesis that the effects of MI, ITM, and EI on drinking will be moderated by alcohol use disorder status and readiness to change drinking such that these interventions will be relatively more efficacious in those with a current disorder and those with low readiness. The study will provide crucial evidence regarding which intervention approaches, alone or in combination, are likely to be most efficient to implement on a large scale in HIV care settings.