Internet-Based Video-Conferencing to Address Alcohol Use and Pain Among Heavy Drinkers in HIV-Care

项目摘要/摘要 慢性疼痛和大量饮酒是艾滋病毒感染者中常见的并存情况 (PLWH)，每一种都会对日常功能和艾滋病毒相关结果产生负面影响。此外， 这些并存的情况对彼此都有重大影响。疼痛是酗酒的重要诱因 在酗酒者中使用，并与与酒精相关的负面后果的经历有关。 在PLWH中，随着时间的推移，中度或更大的疼痛与高风险的饮酒有关。类似地，问题 饮酒会干扰慢性疼痛患者的疼痛控制努力，并与早期辍学有关 从治疗中。临床医生在努力解决这些频繁发生的问题时面临着许多挑战 条件包括患者改变的动力不足，对治疗的坚持性差，以及经常遇到障碍 使用药物治疗来充分治疗这两种情况。考虑到慢性疼痛和 PLWH中大量饮酒及其对日常功能和艾滋病毒结局的综合影响 治疗局限性，综合行为方法将有相当大的好处来解决 以一种可以容易地合并到艾滋病毒护理环境中并容易地 为病人所用。通过UH2/UH3机制，该提案的目标是：1)制定 综合行为视频远程健康干预方法，减少重型患者的疼痛和酒精使用 慢性疼痛的HIV感染患者饮酒并确定其可行性和可接受性(UH2和2) 通过随机对照先导试验(UH3)获得干预效果的效应大小估计。这 这项研究是利用视频远程保健方法解决患者饮酒和疼痛问题的第一次努力 此设置。UH2组件将用于治疗开发和小样本的初步测试 在一个开放的试点中。在这种情况下患者可接受性和可行性的证据，以及发布前 已确定结果的变化将提供数据，作为UH3组成部分的基础 通过随机对照先导试验对干预效果进行初步检验。

PROJECT SUMMARY/ABSTRACT Chronic pain and heavy drinking are common co-occurring conditions among people living with HIV infection (PLWH) each of which have a negative impact on daily functioning and HIV-related outcomes. Moreover, these comorbid conditions have a significant impact on one another. Pain is an important trigger for alcohol use among heavy drinkers and is linked with the experience of negative alcohol-related consequences. Among PLWH, moderate or greater pain has been linked with risky drinking over time. Similarly, problem drinking interferes with pain management efforts among those with chronic pain and is linked to earlier dropout from treatment. Clinicians face a number of challenges in their efforts to address these frequently co-occurring conditions including low patient motivation for change, poor adherence to treatment, and frequent barriers to using pharmacological treatments to adequately treat both conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be readily incorporated into HIV-care settings and easily utilized by patients. Through the UH2/UH3 mechanism the objectives of the proposal are to, 1) develop an integrated behavioral video telehealth intervention approach to reduce pain and alcohol use among heavy drinking HIV-infected patients with chronic pain and determine its feasibility and acceptability (UH2) and 2) obtain effect size estimates of intervention efficacy through a randomized controlled pilot trial (UH3). This study represents a first effort to utilize a video telehealth approach to address alcohol use and pain for patients this setting. The UH2 component will be used for treatment development and initial testing with a small sample of patients in an open pilot. Evidence of patient acceptability and feasibility in this setting along with pre-post changes in identified outcomes will provide data on which to base the UH3 component which will be a preliminary test of intervention efficacy through a randomized controlled pilot trial.