Addressing alcohol misuse in HIV prevention and care: The Brown University Alcohol Research Center on HIV (ARCH)

总体项目摘要 酒精滥用影响了国内和全球艾滋病毒流行的深度和广度， 多重途径--增加性风险行为，减少抗逆转录病毒治疗依从性， 增加HIV相关合并症和死亡率的风险。为了降低艾滋病毒的发病率， 必须制定同时解决在艾滋病毒检测和行为和 生物医学预防方法。同样，为了提高艾滋病毒抑制率，减少艾滋病毒相关的 合并症，酒精滥用必须有效地解决不同人群的艾滋病毒谱 护理机构。布朗大学艾滋病酒精研究中心（Brown University Alcohol Research Center on HIV）一直在支持 合作研究开发可扩展的酒精-艾滋病毒干预措施，包括视频咨询，远程医疗， 和基于网络的应用程序，这些应用程序可以使用集中的人员和 技术资源。这一申请，以更新布朗奖学金是围绕中心主题， 为了实现人口影响，在艾滋病毒预防和护理中解决酒精滥用问题的干预措施 需要进行评估，重点是现实世界的有效性，可扩展性和可持续性，根据 实施科学的原则。具体来说，我们提出了三个项目，利用我们独特的 （a）培训酒精滥用干预方面的专业人员，（B）利用视频咨询， 远程医疗作为可扩展的手段，覆盖人群并提供持续的护理，以及（c）利用行为 干预技术，提供酒精干预措施和持续支持变革。研究 组件1（MPI：Wray和Monti）扩展了我们关于酒精使用在艾滋病毒传播中的作用的工作， 男男性行为者（MSM）通过测试基于网络的干预措施的有效性， 完成艾滋病毒自我检测的男男性行为者的饮酒和性风险。研究组件2（PI：Kahler）扩展 我们在行为远程医疗干预方面的工作，通过测试我们的 以前开发的视频咨询和短信干预在不同样本的艾滋病毒感染者 在四个大的，城市联邦合格的健康中心护理。研究组件1和2共享混合类型 1有效性-实施试验设计，在收集数据的同时提供真实世界有效性的数据 为今后的研究提供信息。研究组件3（MPI：Becker和Kuo） 对这些项目进行补充，进行实施试验，评估级联培训模型， 在南非的艾滋病毒护理机构中推广酒精筛查和简短干预。所有这些 项目-由行政核心，研究方法核心和计划咨询委员会支持 并辅之以酒精-艾滋病毒研究方面的出色培训计划， 机会-将在翻译关于酒精和艾滋病毒的基本和应用知识方面产生重大影响 减少酗酒对艾滋病毒预防和护理的负面影响。

Overall Project Summary Alcohol misuse impacts the depth and breadth of the HIV epidemic, both domestically and globally, through multiple pathways—increasing sexual risk behaviors, reducing adherence to antiretroviral therapy, and increasing the risk for HIV-associated comorbidities and mortality. To reduce the incidence of HIV, approaches must be developed that concurrently address alcohol misuse in the context of HIV testing and behavioral and biomedical prevention approaches. Likewise, to increase rates of HIV viral suppression and reduce HIV-related comorbidities, alcohol misuse must be addressed effectively in diverse populations across a spectrum of HIV care settings. The Brown University Alcohol Research Center on HIV (ARCH) has been supporting collaborative research to develop scalable alcohol-HIV interventions, including video counseling, telehealth, and web-enabled applications, that can be delivered broadly and efficiently using centralized personnel and technological resources. This application to renew the Brown ARCH is organized around the central theme that in order to achieve population impact, interventions addressing alcohol misuse in HIV prevention and care need to be evaluated with an emphasis on real-world effectiveness, scalability, and sustainability, according to the principles of implementation science. Specifically, we propose three projects that leverage our unique strengths in (a) training professionals in alcohol misuse interventions, (b) utilizing video counseling and telehealth as scalable means of reaching populations and providing continuing care, and (c) utilizing behavioral intervention technologies to provide alcohol interventions and ongoing support for change. Research Component 1 (MPI: Wray and Monti) extends our work on the role of alcohol use in HIV transmission among men who have sex with men (MSM) by testing the effectiveness of a web-based intervention that addresses both alcohol use and sex risk in MSM completing HIV self-testing. Research Component 2 (PI: Kahler) extends our work on behavioral telehealth interventions to reduce alcohol misuse in HIV-infected MSM by testing our previously developed video counseling and text messaging interventions in a diverse sample of patients in HIV care at four large, urban federally-qualified health centers. Research Components 1 and 2 share a Hybrid Type 1 effectiveness-implementation trial design, providing data on real-world effectiveness while gathering data related to implementation to inform future studies. Research Component 3 (MPI: Becker and Kuo) complements these projects by conducting an implementation trial that evaluates a cascading training model to promote alcohol screening and brief intervention across HIV care settings in South Africa. Together, these projects—supported by an Administrative Core, Research Methods Core, and Program Advisory Committee and complemented by an outstanding training program in alcohol-HIV research with robust pilot funding opportunities—will make a substantial impact in translating basic and applied knowledge on alcohol and HIV into scalable approaches to reducing the negative impact of alcohol misuse on HIV prevention and care.