HealthCall: Brief Intervention to Reduce Drug Use in HIV Primary Care

描述(申请人提供)：目前的艾滋病毒流行越来越多地涉及非注射毒品使用(NIDU)。对于艾滋病毒感染者，特别是艾滋病毒初级护理中的低收入少数族裔患者等弱势人群，减少NIDU对于改善整体健康和遵守HAART以及减少艾滋病毒的性传播具有重要意义。在减少这一复杂人口的NIDU方面取得进展的一个障碍是缺乏有效的干预措施，对工作人员和资源的需求有限。旨在克服这一障碍的干预措施将动机访谈(MI)与自动电话技术(HealthCall)相结合。干预始于一名顾问针对NIDU进行了一次简短的MI会议。然后，在几乎没有额外工作人员时间的情况下，HealthCall通过患者使用交互式语音响应(IVR)技术来扩展干预范围，该技术提供对NIDU和其他目标行为的行为自我监控。患者在60天内每天都会向IVR打简短的电话。在30天和60天时，MI顾问与患者会面，给他们简短的个性化反馈，讨论根据IVR数据生成的他们的药物使用图表。因此，HealthCall充当了短暂心肌梗死的“临床医生-延伸器”。MI+HealthCall在一个大型大都市艾滋病毒初级保健诊所中对低SES、少数积极使用非注射药物的少数患者进行的一项成功的随机试点研究证明了MI+HealthCall的可接受性和可行性，并与仅使用MI相比，表明了MI+HealthCall在减少药物使用和改善HAART依从性方面的有效性。在相同的环境和患者群体中，MI+HealthCall的三组随机对照试验(RCT)被提出。在这项随机对照试验中，390名患者将被随机分为(1)MI+HealthCall组、(2)仅MI组或(3)教育对照组。评价将在基线、30天和60天以及3个月、6个月和12个月进行。主要结果是减少了主要药物(非注射可卡因、海洛因或甲基苯丙胺)的使用，改善了HAART的依从性，并减少了性危险行为。本课程将探讨中介变量(改变的动机和自我效能)和调节变量(例如，抑郁)。实现研究目标可以帮助减少NIDU，提高HAART的依从性，并减少HIV初级保健患者的性危险行为。更广泛地说，一种新颖的、技术增强的干预措施将被添加到治疗文献中，它可能会改变有关所需临床医生时间与患者参与干预时间之比的概念。这项提议是对NIDA PA-09-236“美国的艾滋病毒/艾滋病、药物使用和弱势群体”的回应。 公共卫生相关性：在艾滋病毒感染者中，非注射药物使用(NIDU)与艾滋病毒用药依从性差、艾滋病毒/艾滋病危险行为增加以及非艾滋病死亡率增加有关。因此，减少艾滋病毒感染者中的NIDU对他们的生存和限制艾滋病毒的传播至关重要。我们建议研究一种技术增强的短期干预措施的有效性，以减少艾滋病毒初级保健患者的NIDU，这种干预对忙碌的医务人员要求很少，并被患者很好地接受。

DESCRIPTION (provided by applicant): The ongoing HIV epidemic increasingly involves non-injection drug use (NIDU). In HIV-infected individuals, particularly vulnerable populations such as low-income minority patients in HIV primary care, reducing NIDU is important to improve overall health and HAART adherence, and to reduce sexual transmission of HIV. A barrier to progress in NIDU reduction for this complex population has been the lack of effective interventions that make limited demands on staff and resources. An intervention designed to overcome this barrier combines Motivational Interviewing (MI) with automated telephone technology (HealthCall). The intervention begins with a counselor administering a brief MI session targeting NIDU. Then, with little additional staff time, "HealthCall" extends the intervention through patient use of Interactive Voice Response (IVR) technology, which provides behavioral self-monitoring of NIDU and other target behaviors. Patients make brief daily calls to the IVR for 60 days. At 30 and 60 days, MI counselors meet with patients and give them brief personalized feedback, discussing a graph on their drug use generated from the IVR data. Thus, HealthCall serves as a "clinician-extender" of the brief MI. A successful randomized pilot study of MI+HealthCall among low-SES, minority patients with active non- injection drug use in a large, metropolitan, HIV primary care clinic demonstrated acceptability and feasibility of MI+HealthCall, and, compared to MI-only, suggested efficacy of MI+HealthCall in reducing drug use and improving HAART adherence. A 3-arm randomized controlled trial (RCT) of MI+HealthCall is proposed in the same setting and patient population. In this RCT, 390 patients will be randomized to (1) MI+HealthCall, (2) MI-only or (3) educational control. Evaluations will be done at baseline, 30 and 60 days, and at 3, 6 and 12 months. Main outcomes are reduction in use of primary drug (non-injection cocaine, heroin or methamphetamine), improved HAART adherence, and reduced sexual risk behavior. Mediators (motivation to change and self-efficacy) and moderators (e.g., depression) will be explored. Achieving study aims could help reduce NIDU, improve HAART adherence and reduce sexual risk behaviors in HIV primary care patients. More broadly, a novel, technologically-enhanced intervention would be added to the treatment literature that could change concepts about the ratio of required clinician time to the duration of patient participation in an intervention. This proposal is responsive to NIDA PA-09-236 "HIV/AIDS, Drug Use, and Vulnerable Populations in the US". PUBLIC HEALTH RELEVANCE: Among HIV-infected individuals, non-injection drug use (NIDU) is associated with poor HIV medication adherence, greater HIV/AIDS risk behaviors, and increasing non-AIDS mortality. Thus, reducing NIDU among HIV-infected individuals is critical to their survival and to limiting the spread of HIV. We propose to study the efficacy of a technologically-enhanced brief intervention to reduce NIDU in HIV primary care patients that demands little from busy medical staff and is well-accepted by patients.