3/3 Alcohol Research Consortium in HIV – Intervention Research Arm (ARCH-IRA)

酒精使用障碍（AUD）和危险饮酒是美国第四大可预防死亡原因。 在美国，它占所有工作年龄成年人死亡人数的10%。艾滋病毒/艾滋病感染者 （PLWH），重度酒精使用率是普通人群的两倍。很少有人参与行为 酒精治疗和酒精药物疗法并不常规用作酒精治疗的一部分，尽管 这些干预措施的已知功效。艾滋病毒感染者和艾滋病患者定期接受治疗， 与医疗提供者联系，并在医疗家庭模式中接受治疗，其中所有医疗服务都是 在艾滋病毒诊所内提供，但很少有艾滋病毒提供者对治疗AUD感到舒服。在我们最初的融资过程中， 在此期间，我们实施了常规酒精筛查，开发了计算机化简短干预（CBI），并且 进行了酒精药物治疗的提供者培训。然而，尽管我们发现了来自 CBI的常规筛查以减少酒精使用，很少有提供者规定酒精药物治疗， 尽管有这种专门的培训，但大多数人表示持续的不适和缺乏使用知识， 药物治疗.算法通常用于指导提供者为许多不同的患者选择治疗方案。 不属于其专业范围的疾病，如糖尿病管理、肥胖、关节炎和其他 紊乱此外，我们还测试了使用供应商算法治疗抑郁症和吸烟 与PLWH，并证明增加利用这些药物。对于这次更新，我们建议 实现科学测试使用算法，该算法将建立在我们与CBI的成功之上， 酒精药物疗法和其他行为疗法在常规治疗。一种决策树算法 提供更密集的治疗，包括酒精药物治疗，也对 将在CFAR网络的三个艾滋病毒诊所对抑郁或焦虑症状等合并症进行检测 集成临床系统（CNICS）。主要结果包括减少酒精消费， 频率，改善艾滋病毒结果和改善共病状况。我们还将检查供应商， 工作人员、患者和临床水平的促进者以及在常规临床护理中实施该算法的障碍。 这种治疗方法的成功实施将对降低AUD产生相当大的影响 在PLWH中，可以将其整合到现有的电子健康记录系统中，以实现可持续模式 酒精治疗提供给其他艾滋病诊所。

Alcohol Use Disorders (AUDs) and hazardous drinking are the fourth leading cause of preventable death in the US and are responsible for 10% of all deaths among working age adults. Among Persons Living with HIV/AIDS (PLWH), heavy alcohol use is up to twice the rate in the general population. Few people engage in behavioral alcohol treatment and alcohol pharmacotherapies are not routinely used as part of alcohol treatment, despite the known efficacy of these interventions. PLWH engaged in treatment for their HIV disease have regular contact with a medical provider and are treated in a medical home model in which all medical services are delivered within HIV clinics, but few HIV providers feel comfortable treating AUDs. During our initial funding period, we implemented routine alcohol screening, developed a computerized brief intervention (CBI), and conducted provider training on alcohol pharmacotherapies. However, while we found a strong impact from routine screening with CBI for reducing alcohol use, few providers prescribed alcohol pharmacotherapy, despite this specialized training, with most indicating continued discomfort and lack of knowledge for use of pharmacotherapy. Algorithms are used routinely to guide providers in treatment selection for many different disorders that are not within their specialty such as diabetes management, obesity, arthritis, and other disorders. In addition, we tested the use of provider algorithms for the treatment of depression and smoking with PLWH and demonstrated increased utilization of these medications. For this renewal, we are proposing an implementation science test of using an algorithm that will build upon our success with CBI and integrate alcohol pharmacotherapies and other behavioral therapies within routine treatment. A decision-tree algorithm that provides more intensive treatments, including alcohol pharmacotherapies, that is also responsive to comorbidities such as depressive or anxiety symptoms will be tested in three HIV clinics across CFAR Network of Integrated Clinical Systems (CNICS). Primary outcomes include reduced alcohol consumption and frequency, improved HIV outcomes, and improvement in comorbid conditions. We will also examine provider, staff, patient, and clinic-level facilitators and barriers to implementation of this algorithm in routine clinical care. Successful implementation of this treatment approach would have considerable impact on reducing AUDs among PLWH and could be integrated within existing electronic health record systems for a sustainable model of alcohol treatment delivery to other HIV clinics.