A Telemedicine and mHealth Intervention for Reducing Alcohol Consumption among People Living with HIV/AIDS.

项目摘要/摘要 随着治疗的进步，艾滋病毒/艾滋病患者(PLWHA)大大提高了存活率和 医疗结果。然而，尽管高效抗逆转录病毒疗法的可用性增加，但许多 PLWHA没有按照指示服用他们的药物。这降低了他们实现病毒抑制和 因此，这是艾滋病毒/艾滋病治疗级联的一个重要组成部分。为了改善PLWHA的成果并 解决在全国范围内观察到的病毒抑制水平较低的问题，至关重要的是检查可能 以减少服药依从性。一个这样的因素是酒精消费，这已经被证明有 对个人是否遵循他们的药物治疗方案有重大而重大的影响。 这项研究的主要目的是开发和测试PLWHA的酒精减少干预。 基于合作者之前的研究和先前的文献，这项为期八周的干预措施名为跟踪和 减少酒精消耗(TRAC)，将完全利用技术提供。辅导员将与 与佐治亚州公共卫生部的远程健康合作使用视频会议的患者 通过网络以及基于电话的对话。这种基于技术的交付将高度可访问 佐治亚州农村和城市地区的患者，因为只需要亲自去当地医疗机构看两次 用于视频会议会议的部门办公室。作为干预的补充，参与者还将 通过移动问卷对饮酒和服药依从性进行自我监测 以及蓝牙呼气测定仪。移动呼气测定仪的使用代表了 现代技术，并有可能提高自我报告的酒精消费的有效性。总的来说， TRAC干预措施将分两个阶段进行开发和测试：开放试验(N=10)，探索接受情况 和可用性，以及一项小型随机试点试验(N=60)，评估在以下方面的可行性和有效性证据 到减少酒精消耗、提高服药依从性和改善医疗结果。 我的目标是接受全面的培训，以支持这项与减少饮酒有关的研究 在PLWHA中。作为我培训计划的一部分，五位专门研究艾滋病毒/艾滋病、酗酒、干预的导师 设计、远程医疗和高级数据分析将通过定期定向阅读提供指导 会议和对研究设计的反馈。这些导师位于佐治亚大学和耶鲁大学 大学。这两所大学将为我提供广泛的智力资源和合作伙伴关系 可以帮助我进行研究的组织，包括佐治亚州公共卫生部、耶鲁大学中心 关于艾滋病的跨学科研究，以及NIAAA艾滋病毒/艾滋病和酒精相关研究联盟 审判。我还将参加与临床数据分析、艾滋病毒/艾滋病研究以及 行为干预设计。这次培训将为我提供满足我长期工作所需的基础。 目标是开展由外部资助的艾滋病毒/艾滋病以及酒精和药物使用方面的研究计划。

Project Summary/Abstract With advances in treatment, people living with HIV/AIDS (PLWHA) have greatly improved survival rates and medical outcomes. However, despite the increased availability of highly-active antiretroviral therapy, many PLWHA fail to take their medication as directed. This reduces their chances of achieving viral suppression and is thus a crucial component of the HIV/AIDS treatment cascade. To improve the outcomes of PLWHA and address the low levels of viral suppression observed nationwide, it is essential to examine factors that are likely to decrease medication adherence. One such factor is alcohol consumption, which has been shown to have a significant and large effect on whether or not individuals follow their medication regimen. The primary objective of this research is to develop and test an alcohol reduction intervention for PLWHA. Based on collaborators’ previous research and prior literature, this eight-week intervention, titled Tracking and Reducing Alcohol Consumption (TRAC), will be delivered entirely using technology. Counselors will meet with patients using videoconferencing in partnership with the Georgia Department of Public Health’s Telehealth Network, as well as via phone-based conversations. This technology-based delivery will be highly accessible to patients in both rural and urban areas of Georgia, as it requires only two in-person visits to a local health department office for videoconferencing sessions. As a supplement to the intervention, participants will also engage in self-monitoring of alcohol consumption and medication adherence through mobile questionnaires and Bluetooth-enabled breathalyzers. The use of mobile breathalyzers represents an innovative application of modern technologies and has potential to improve the validity of self-reported alcohol consumption. Overall, the TRAC intervention will be developed and tested in two stages: an open trial (N=10) exploring acceptance and usability, and a small randomized pilot trial (N=60) assessing feasibility and evidence for efficacy in regard to reducing alcohol consumption, increasing medication adherence, and improving medical outcomes. I aim to receive comprehensive training to support this line of research related to reducing alcohol consumption among PLWHA. As part of my training plan, five mentors who specialize in HIV/AIDS, alcohol, intervention design, telemedicine, and advanced data analysis will provide guidance through directed readings, regular meetings, and feedback on research design. These mentors are located at the University of Georgia and Yale University. Both universities will provide me with access to extensive intellectual resources and partnering organizations who can aid in my research, including the Georgia Department of Public Health, Yale’s Center for Interdisciplinary Research on AIDS, and the NIAAA Consortia for HIV/AIDS and Alcohol-Related Research Trials. I will also participate in courses and workshops related to clinical data analysis, HIV/AIDS research, and behavioral intervention design. This training will provide me with the foundation needed to meet my long-term goal of conducting an externally-funded program of research in HIV/AIDS and alcohol and drug use.