Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA)

项目摘要/摘要 赞比亚阿拉巴马州艾滋病毒酒精共患病计划(ZAMBAMA)的总体目标是(Aim 1)检测 跨诊断模式的有效性，通用元素治疗方法(CETA)，以减少 在资源不足的艾滋病毒诊所中不健康的饮酒和改善艾滋病毒临床结果，(目标2)评估 CETA影响艾滋病毒结果的机制，(目标3)调查 CETA因临床(如合并症的存在)、人口统计(如性别)和/或背景因素而异 (例如，赞比亚、阿拉巴马州)和(目标4)审查与一体化有关的执行因素，包括成本 向艾滋病毒携带者和前线不健康饮酒的弱势人群提供减少酒精干预- 排好艾滋病诊所的队伍。P01‘S的中心主题是，在艾滋病毒携带者和不健康饮酒者中，整合 常见行为和精神健康并存的筛查和治疗将减少不健康的饮酒 并改善艾滋病毒的治疗结果。ZAMBAMA将由一个协作团队实施，该团队将带来 由老牌和年轻的研究人员组成的小组共同努力解决艾滋病毒之间的科学差距， 全球艾滋病毒应对措施中优先地理区域的物质使用和精神疾病：撒哈拉以南非洲 和美国南部，该团队将共同在成人中实施两项随机对照临床试验 艾滋病毒和不健康的酒精使用评估CETA对酒精使用的影响，艾滋病毒护理连续体(抗逆转录病毒 坚持治疗、参与和保留艾滋病毒护理、病毒抑制)以及共同的心理健康和 物质使用合并症。项目1(赞比亚的CETA艾滋病毒减少酒精试验--查茨) 在赞比亚的公共部门初级艾滋病毒诊所实施，在那里现有的艾滋病毒“同伴教育者”(即 辅导员)将接受培训，在面对面为参与者提供酒精短暂干预(BI)和CETA 会话。项目2(使用CETA-滑石粉对艾滋病毒携带者使用不健康酒精的远程医疗) 将招募在社区瑞安·怀特艾滋病毒/艾滋病计划资助的诊所接受艾滋病毒护理的参与者 阿拉巴马州，服务于不同的农村人口。研究生级别的提供者(由有执照的诊所监督 心理学家)将使用远程医疗方法远程提供干预(BI和CETA) 在新冠肺炎大流行期间迅速扩张。这两个研究项目还将评估实施情况 因素，以增强临床疗效数据的影响，两个项目都将得到3个资源的支持 CORES：CETA临床干预培训和监督的核心，协调方法和分析的核心 跨项目的数据元素，并在数据分析中创建协同效应，以及管理核心 P01的业务和监管要求，监测和管理总体进展，并推动 以美国南部和撒哈拉以南非洲为重点的双向知识和思想交流 调查人员。

Project Summary/Abstract The overall aims of the Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA) are to (Aim 1) test the effectiveness of a transdiagnostic model, Common Elements Treatment Approach (CETA), to reduce unhealthy alcohol use and improve HIV clinical outcomes in under-resourced HIV clinics, (Aim 2) evaluate the mechanisms through which CETA impacts HIV outcomes, (Aim 3) investigate whether the treatment effect of CETA varies by clinical (e.g., presence of comorbidities), demographic (e.g., gender) and/or contextual factors (e.g., Zambia, Alabama), and (Aim 4) examine implementation factors, including cost, related to integrated delivery of alcohol reduction interventions to disadvantaged people with HIV and unhealthy alcohol use at front- line HIV clinics. The P01’s central theme is that, among people with HIV and unhealthy alcohol use, integrated screening and treatment of common behavioral and mental health comorbidities will lower unhealthy alcohol use and improve HIV treatment outcomes. ZAMBAMA will be implemented by a collaborative team that brings together groups of established and young investigators working to address scientific gaps at the nexus of HIV, substance use, and mental illness in priority geographical areas in the global HIV response: sub-Saharan Africa and the Southern U.S. Together, the team will implement two randomized controlled clinical trials in adults with HIV and unhealthy alcohol use to evaluate CETA’s effects on alcohol use, the HIV care continuum (antiretroviral therapy adherence, engagement and retention in HIV care, viral suppression), and common mental health and substance use comorbidities. Project 1 (CETA HIV Alcohol Reduction Trial in Zambia - CHARTZ) will be implemented at public sector primary HIV clinics in Zambia where existing HIV ‘peer educators’ (i.e., lay counselors) will be trained to provide an alcohol brief intervention (BI) and CETA to participants at in-person sessions. Project 2 (Telemedicine for Unhealthy Alcohol Use in Persons Living with HIV using CETA - TALC) will enroll participants receiving HIV care at community Ryan White HIV/AIDS program-funded clinics across Alabama that serve diverse and rural populations. Graduate-level providers (supervised by a licensed clinical psychologist) will provide the interventions (BI and CETA) remotely using telemedicine approaches that were rapidly expanded during the COVID-19 pandemic. Both research projects will also evaluate implementation factors, to enhance the impact of clinical effectiveness data, and both projects will be supported by 3 resource cores: a CETA core for clinical intervention training and oversight, a Methods and Analysis core to harmonize data elements across projects and create synergy in data analyses, and an Administrative core to manage business and regulatory requirements of the P01, monitor and manage overall progress, and promote bidirectional knowledge and idea exchange between Southern U.S.- and sub-Saharan Africa-focused investigators.