TALC

项目摘要 酒精使用障碍、物质使用障碍和精神健康并存是终止 艾滋病毒的流行。阿拉巴马州和美国其他优先州的情况尤其如此。‘结束艾滋病毒 “流行病”倡议。解决南方腹地不健康的饮酒和精神健康并存问题 由于贫困和缺乏公共卫生服务而变得困难。因为在低资源的情况下面临着类似的挑战 环境、为低收入和中等收入国家制定的干预措施有望减少 阿拉巴马州HIV感染者(PLWH)的不健康饮酒和改善心理社会共病 这对这些人口的影响不成比例。旨在解决LMIC有限的精神卫生工作人员问题， 普通元素治疗方法(CETA)是一种很有前途的治疗不健康饮酒和精神疾病的方法 阿拉巴马州的健康合并症。CETA是一种基于认知行为疗法的多疗程干预 使用跨诊断技术来解决酒精使用、其他物质使用和精神健康问题 通过单一提供商提供症状。CETA已在至少7个LMIC中被证明有效，并得到了具体的支持 用于减少抑郁症状和不健康的酒精滥用。这项拟议的研究是一项随机试验， 使用CETA对艾滋病毒携带者使用不健康的酒精进行远程医疗(滑石粉研究)，以实现 目的：1)评价T-CETA在长春市人群中不健康饮酒的效果；2)评价T-CETA在长春市人群中的不良饮酒效果 T-CETA对HIV结局的有效性，3)评价T-CETA对SUD和MENTAL的有效性 健康并存，以及4)评估与向有以下疾病的人提供BI和T-CETA相关的实施因素 阿拉巴马州社区诊所在护理中使用艾滋病毒不健康酒精的可行性、可接受性、成本和 成本效益。来自阿拉巴马州社区艾滋病毒诊所的PLWH(n=308)将参加试验。 如果患者在经过验证的工具(审核)上自我报告不健康的酒精使用情况，则有资格获得该工具的评估 每4-6个月一次，作为常规护理的一部分。参与者将被随机进行1：1的短暂酒精干预(BI) 与BI加T-CETA(每臂154例)比较。这是两个计划项目之一，旨在测试 CETA关于不健康饮酒、精神健康合并症和居住在#年的PLWH中的艾滋病毒结局 服务不足的地区。如果该项目的目标得以实现，它将大大提高我们对战略的理解 以减少艾滋病在阿拉巴马州的发展和传播，并推进总统结束 艾滋病毒流行。在达致这些目标后，我们计划在多个地点进行实施研究，以 解决执行情况评估(目标4)中确定的障碍，并将研究结果转化为例行程序 在其他优先考虑的州开展社区护理，以减少整个美国南部的艾滋病毒。

Project Abstract Alcohol use disorders, substance use disorders, and mental health comorbidities are a major threat to ending the HIV epidemic. This is especially the case in Alabama and other priority states within the U.S. ‘Ending the HIV Epidemic’ initiative. Addressing unhealthy alcohol use and mental health comorbidities in the Deep South is made difficult by poverty and lack of public health services. Because of the similar challenges in low-resource settings, interventions developed for low and middle-income countries (LMIC) hold promise for reducing unhealthy alcohol use in people living with HIV (PLWH) in Alabama and improving psychosocial comorbidities that disproportionately impact this population. Designed to address the limited mental health workforce in LMIC, Common Elements Treatment Approach (CETA) is a promising treatment for unhealthy alcohol use and mental health comorbidities in Alabama. CETA is a multi-session cognitive behavioral therapy-based intervention that employs transdiagnostic techniques to address comorbid alcohol use, other substance use, and mental health symptoms through a single provider. CETA has been proven effective in at least 7 LMICs, with specific support for reducing depressive symptoms and unhealthy alcohol misuse. The proposed study is a randomized trial, Telemedicine for unhealthy Alcohol use in persons Living with HIV using CETA (TALC study), to achieve the following aims: 1) Evaluate the effectiveness of T-CETA on unhealthy alcohol use among PLWH, 2) Evaluate the effectiveness of T-CETA on HIV outcomes, 3) Evaluate the effectiveness of T-CETA on SUD and mental health comorbidities, and 4) Evaluate implementation factors related to BI and T-CETA provision to people with HIV unhealthy alcohol use in care at community clinics in Alabama including feasibility, acceptability, cost and cost-effectiveness. PLWH (n = 308) from community-based HIV clinics in Alabama will be enrolled in the trial. Patients will be eligible if they self-report unhealthy alcohol use on a validated tool (AUDIT), which is assessed every 4-6 months as part of routine care. Participants will be randomized 1:1 to a brief alcohol intervention (BI) versus BI plus T-CETA (n = 154 per arm). This is one of two program projects aiming to test the effectiveness of CETA on unhealthy alcohol use, mental health comorbidities, and HIV outcomes among PLWH residing in underserved areas. If the project aims are achieved, it will significantly advance our understanding of strategies to reduce HIV disease progression and transmission in Alabama and advance the President’s Plan to End the HIV Epidemic. Following achievement of these aims, we plan to conduct a multi-site implementation study to address barriers identified in the implementation assessment (Aim 4) and translate study findings into routine community care in other priority states for reducing HIV across the Southern U.S.