Brief couples-based alcohol intervention for HIV-infected MSM and their primary partners

项目摘要 HIV感染患者大量饮酒导致抗逆转录病毒治疗依从性不佳 (ART)，更大的性风险，更高的病毒载量，以及肝脏和认知功能恶化。同性恋， 双性恋和其他男男性行为者(MSM)仍然占所有艾滋病毒/艾滋病的近一半 在美国的病例中，大量饮酒在这一艾滋病毒感染亚群中尤其高。简介 激励性干预措施已被证明可以减少感染艾滋病毒的男男性接触者的饮酒； 然而，这些个人层面的干预措施在减少饮酒方面仅显示出温和的效果。 这表明，持续的行为改变需要关注社会和人际关系 上下文也是如此。到目前为止，还没有以夫妇为基础的简短干预措施来解决酗酒问题 在感染艾滋病毒的男男性接触者及其主要伴侣中不需要戒酒治疗的使用 目标。此外，目前还没有公布的关于夫妻饮酒变化程度的数据 与关键的艾滋病毒相关结果有关(抗逆转录病毒药物治疗、病毒抑制、性风险)。这样做的总体目标是 项目是开发和测试可行性、可接受性和初步效果的简要情侣为主 针对感染艾滋病毒的男男性接触者及其主要伴侣大量饮酒的动机干预。 这个治疗开发项目建立在我们对艾滋病毒的个人层面的动机干预(MI)的基础上- 通过使用我们重要的他人参与的动机干预(SO-MI)中的组件感染MSM 和以夫妇为基础的艾滋病毒预防干预措施，并试图提供对 夫妻层面的行为改变，包括动机、个人和二元性自我效能感以及伴侣支持。 将使用两步疗法开发序列来实现这些目标。第1a阶段包括 与主要信息者的访谈(N=15对夫妇)、手动开发、治疗师培训和单臂 进行定性离职访谈的飞行员(N=12对夫妇)。阶段1b包括一项小规模随机临床试验 哪50名酗酒感染艾滋病毒的男男性接触者将被随机分配到任何一对夫妇干预中， 涉及其伴侣的参与，或对现有的个人干预，这并不是。两者都有 条件包括为期一个月的四次会议。参与者将接受采访 基线、3个月和6个月。调查结果将提供有关可行性、可接受性和 以夫妇为基础的动机干预减少HIV-1人群饮酒的初步效果 被感染的男男性接触者及其主要伴侣。如果这项研究显示出初步的前景，我们将利用研究结果 支持R01应用程序，以在完全有效的随机对照试验中测试干预效果。 本研究可为改善HIV感染的重度饮酒男男性接触者的健康状况提供依据。

Project Summary Heavy alcohol use in HIV-infected patients contributes to suboptimal adherence to antiretroviral therapy (ART), greater sexual risk taking, higher viral loads, and worsened liver and cognitive functioning. Gay, bisexual, and other men who have sex with men (MSM) continue to represent almost half of all HIV/AIDS cases in the United States, and heavy drinking is particularly high among this HIV-infected sub-group. Brief motivational interventions have been shown to reduce alcohol consumption among HIV-infected MSM; however, these individual-level interventions have demonstrated only modest effects in reducing drinking in this population, indicating that sustained behavior change requires attending to social and interpersonal contexts as well. To date, there are no existing brief, couples-based interventions to address heavy alcohol use among HIV-infected MSM and their primary partners that do not require alcohol abstinence treatment goals. Furthermore, there are no published data on the extent to which changes in couples alcohol use relate to key HIV-related outcomes (ART adherence, viral suppression, sexual risk). The overall aim of this project is to develop and test the feasibility, acceptability, and preliminary efficacy of a brief couples-based motivational intervention to address heavy alcohol use among HIV-infected MSM and their primary partner. This treatment development project builds on our individual-level motivational intervention (MI) with HIV- infected MSM by using components from our significant other-involved motivational intervention (SO-MI) and couples-based HIV prevention interventions, and seeks to provide insights into the mechanisms of couple-level behavior change, including motivation, individual and dyadic self-efficacy, and partner support. A two-step sequence of treatment development will be used to achieve these aims. Stage 1a includes interviews with key informants (N = 15 couples), manual development, therapist training, and a one-arm pilot with qualitative exit interviews (N = 12 couples). Stage 1b consists of a small-randomized clinical trial in which 50 heavy drinking HIV-infected MSM will be randomly assigned to either couples intervention, which involves participation of their partner, or to the existing individual intervention, which does not. Both conditions will consist of four sessions conducted over a one-month period. Participants will be interviewed at baseline, and 3-months and 6-months. Findings will provide data on the feasibility, acceptability and preliminary efficacy of the couples-based motivational intervention to reduce alcohol use among HIV- infected MSM and their primary partners. If this research shows initial promise, we will use findings to support an R01 application to test the intervention efficacy in a fully powered randomized controlled trial. This research could provide a foundation for improving the health of HIV-infected heavy drinking MSM.