Technology-based assessments and intervention to reduce alcohol consumption and improve HIV viral suppression in the Florida Cohort

摘要 在美国，大多数艾滋病病毒携带者(PWH)都饮酒，尽管饮酒与 较低的艾滋病毒护理参与度和艾滋病毒病毒抑制水平。在过去的十年里，我们的研究团队 建立了佛罗里达队列以支持研究和培训，其使命是最大限度地利用艾滋病毒病毒 抑制和改善威斯康星医院的健康结果。佛罗里达队列的主要特征包括专注于 与酒精有关的问题，全州的学术和社区伙伴关系，有针对性地招收 不同的人群，以及与全州艾滋病毒监测数据的联系。与此同时，佛罗里达州的几家机构 正在实施新的干预措施，以帮助实现艾滋病毒抑制，包括PositiveLinks(PL) 应用程序。目前赠款提案的首要目标是促进对这些机制的了解 影响对当代艾滋病毒治疗方案的遵守，并纳入与酒精有关的 对新出现的战略进行干预，以实现和维持对不同领域的艾滋病毒病毒的抑制 人口。我们建议招募和调查1200名新的佛罗里达州队列参与者，并进行有针对性的登记 对于酗酒者和性/少数民族。调查数据将使我们能够确定多层次的因素 有助于在使用酒精的PWH中坚持抗逆转录病毒治疗和病毒抑制。在整个队列中，有80人 酗酒者将完成为期一个月的“强化监测(EM)”。EM组将佩戴手腕 酒精生物传感器，报告酒精和其他风险因素(例如，实时焦虑、抑郁)和ART 通过生态瞬时评估(EMA)应用程序遵守，并提供两个干血点(DBS) 病毒负载测试。EM数据将有助于理清酒精和其他风险之间的时间关系 因素，以及实时的艺术坚持。调查和新兴市场数据以及新兴市场参与者的投入将 用于通报基于生物传感器的干预的几个方面的发展。我们的跨学科 小组还将定期与新的社区/提供商咨询委员会(CAB)举行会议，该委员会将提供意见 与正在进行的佛罗里达队列相关(例如，登记、调查设计)，并帮助制定计划，将 酒精生物传感器对PL应用程序的干预。具体目标包括：1)系统调研 以社会-生态模式和世卫组织模式为基础的影响抗逆转录病毒治疗依从性和 随后，在使用酒精与不使用PWH的情况下，HIV病毒被抑制。2)在80%的酒精中使用PWH，使用 酒精生物传感器和EMA数据，最有力地识别酒精消费模式和风险因素 与不遵守抗逆转录病毒疗法和不良的艾滋病毒抑制有关。3)制定一种干预措施， 将酒精生物传感器整合到现有的mHealth ART依从性干预中，投入来自 使用酒精的威斯康星医院和一个社区/提供者咨询委员会。我们在这个项目中收集的丰富信息 将为我们的下一步奠定坚实的基础：对集成的 酒精干预覆盖了佛罗里达州以诊所/社区为基础的艾滋病毒设置的大型网络。

SUMMARY The majority of persons with HIV (PWH) in the US consume alcohol, despite that alcohol use is associated with lower levels of HIV care engagement and HIV viral suppression. Over the past decade, our research team has established the Florida Cohort to support research and training with a mission to maximize HIV viral suppression and improve health outcomes in PWH. Key features of the Florida Cohort include a focus on alcohol-related issues, academic and community-based partnerships across the state, targeted enrollment of diverse populations, and linkage to statewide HIV surveillance data. Meanwhile, several agencies in Florida are implementing new interventions to help achieve HIV viral suppression, including the PositiveLinks (PL) app. The overarching goals of the current grant proposal are to advance understanding of the mechanisms influencing adherence to contemporary HIV therapeutic regimens, and to incorporate alcohol-related interventions into emerging strategies to achieve and maintain HIV viral suppression across diverse populations. We propose to enroll and survey 1200 new Florida Cohort participants, with targeted enrollment for heavy drinkers and sexual/ethnic minorities. The survey data will allow us to identify multilevel factors contributing to ART adherence and viral suppression among alcohol-using PWH. From the overall cohort, 80 alcohol-using PWH will complete “enhanced monitoring (EM)” for one month. The EM group will wear a wrist alcohol biosensor, report alcohol and other risk factors (e.g., real-time anxiety, depression) and ART adherence through an ecological momentary assessment (EMA) app, and provide two dried blood spots (DBS) viral load tests. The EM data will help disentangle the temporal relationships between alcohol, other risk factors, and ART adherence in real-time. Survey and EM data together with input from the EM participants will be used to inform the development of several aspects of the biosensor-based intervention. Our interdisciplinary team will also meet regularly with a new Community/Provider Advisory Board (CAB), who will provide input related to the ongoing Florida Cohort (e.g., enrollment, survey design) and help develop a plan to integrate the alcohol biosensor-based intervention into the PL app. The specific aims include: 1) Systematically investigate multilevel factors based on the social-ecological model and WHO model that influence ART adherence and subsequently HIV viral suppression in alcohol-using vs. non-using PWH. 2) In 80 alcohol-using PWH, use alcohol biosensors and EMA data to identify alcohol consumption patterns and risk factors most strongly associated with ART non-adherence and poor HIV viral suppression. 3) Develop an intervention that incorporates an alcohol biosensor into an existing mHealth ART adherence intervention, with input from alcohol-using PWH and a Community/Provider Advisory Board. The rich information we collect in this project will establish a solid foundation for our next step: a hybrid implementation/effectiveness trial of an integrated alcohol intervention across a large network of clinic-/community-based HIV settings in Florida.