The HIV and Alcohol Research center focused on Polypharmacy (HARP)

HARP总体项目摘要 艾滋病毒和酒精研究中心的目标集中在多药（HARP）是设计和 对经历医疗伤害的艾滋病毒（PAH）感染者实施有效的个性化干预措施 不健康的酒精使用（风险和酒精使用障碍[AUD]）和多种药物（5+药物）。 使用大规模的国家退伍军人医疗保健管理局电子健康记录数据（EHR数据），我们 已经显示出强烈的独立，剂量反应，多药（药物计数和 A-PIMS），酒精使用和不良健康结果。在HARP项目1中，我们进一步探索酒精， 使用直接酒精生物标志物（磷脂酰乙醇[PEth]）的多药（AP）风险，考虑遗传因素 失代偿性肝硬化是酒精相关性肝硬化的表现， 肝病（AALD）。多种药物和遗传易感性也使AUD治疗的选择复杂化。在 HARP项目2，我们使用遗传易感性和现实世界的数据来识别和评估候选药物， 多药疗法的背景。此外，AP风险，特别是遗传责任，是复杂和具有挑战性的， 总结一下。这两种方法都总结了多种风险因素的影响，并使用遗传数据来确定药物， 重新利用需要大规模的真实世界数据、高性能计算和复杂的分析。 在我们的行政/数据分析（ADA）核心、能源部（DOE）的支持下， VA家庭的EHR队列（VACo家庭），以及扩大的专家网络，我们是独一无二的准备， 利用“大”数据来个性化PAH的AP风险并评估AUD的药物。最后，有效 AP风险信息的传达需要整合到一个全面的、基于理论的行为中 改变干预。我们已经组建了一个由专家组成的风险沟通核心（RCC）， 沟通和动机访谈（MI）在我们的试点干预研究。核心包括杰弗里博士 费舍尔是健康行为改变的信息-动机-行为技能（IMB）模型的共同开发者。在 通过与Fisher博士的合作，这个核心将指导我们应用IMB-MI模型进行沟通， 个性化的风险和其他因素所需的健康行为的变化在一个链接系列的药剂师- 提供试点干预措施。项目1试点将比较患者对AP风险信息的反应（采用 不同的暴露和结局指标），在IMB-MI干预的更大背景下提供， PAH高危饮酒者;项目2试点将纳入项目1中的经验教训，并调整IMB- 针对PAH伴AUD的MI干预，增加AUD的候选再用途药物。

HARP OVERALL PROJECT SUMMARY The goal of the HIV and Alcohol Research center focused on Polypharmacy (HARP) is to design and implement effective personalized interventions for people aging with HIV (PAH) experiencing medical harm from unhealthy alcohol use (at risk and Alcohol Use Disorder [AUD]) and polypharmacy (5+ medications). Using large scale, national Veterans Healthcare Administration Electronic Health Record data (EHR data), we have shown strong independent, dose-response, associations between polypharmacy (medication count and A-PIMS), alcohol use, and adverse health outcomes. In HARP Project 1, we further explore alcohol and polypharmacy (AP) risks using a direct alcohol biomarker (Phosphatidylethanol [PEth]), considering genetic liability, and exploring associations with decompensated liver cirrhosis as a manifestation of alcohol-associated liver disease (AALD). Polypharmacy and genetic liability also complicate selection of treatment for AUD. In HARP Project 2, we use genetic liability and real-world data to identify and evaluate candidate medications in the context of polypharmacy. Further, AP risks, especially genetic liability, are complex and challenging to summarize. Both summarizing effects of multiple risk factors and using genetic data to identify medications for repurposing requires large-scale, real-world data, high performance computing and sophisticated analytics. With support from our Administrative/Data Analytic (ADA) Core, the Department of Energy (DOE), an extended VA family of EHR cohorts (VACo Family), and an expanded network of experts, we are uniquely poised to harness “big” data to personalize AP risks for PAH and evaluate medications for AUD. Finally, effective communication of AP risk messages needs to be integrated into a comprehensive, theory-based behavior change intervention. We have assembled a Risk Communication Core (RCC) of experts to facilitate risk communication and motivational interviewing (MI) in our pilot intervention studies. The core includes Dr. Jeffrey Fisher, co-developer of the Information-Motivation-Behavioral Skills (IMB) model of health behavior change. In collaboration with Dr. Fisher, this core will guide our application of the IMB-MI model to communicate personalized risk and other elements required for health behavior change in a linked series of pharmacist- delivered pilot interventions. Project 1 pilots will compare patient’s responses to AP risk messages (employing different measures of exposure and outcomes) delivered in the larger context of an IMB-MI intervention for PAH who are at risk drinkers; Project 2 pilots will incorporate lessons learned in Project 1 and adapt the IMB- MI intervention to target PAH with AUD, adding a candidate repurposed medication for AUD.