Translational Methods for Developing and Testing a Multi-Target Brief Intervention to Reduce Alcohol Use and Increase ART Adherence among Racially Diverse PLWH

摘要 艾滋病毒感染者（PLWH）在酒精水平较低时，全因死亡率的风险增加 与未受感染的人相比， 在非裔美国人中，尽管饮酒量相当或较低。此外，酒精的有害影响， 据报道，低收入城市人群的抗逆转录病毒治疗依从性和临床结果。而且是 建议PLWH接受常规酒精筛查，并以证据为基础的简短动机 干预措施（MI）被采用时，他们的屏幕积极。事实上，MI是公认的有效的， 减少广泛患者的消耗，并且已证明以依从性为重点的MI可改善 在PLWH中坚持。虽然有证据支持针对酒精和 坚持是有希望的，多疗程干预通常难以对高风险患者实施 并且没有研究评估针对两者的单次MI。 在许多艾滋病毒环境中，即使是短暂的MI也存在障碍，例如竞争性免疫， 密集的需求，有限的资源，以及缺乏专门的酒精专业知识。远程医疗技术提供了 可行的解决方案。我们的团队在开发有效的以酒精为重点的MI和多靶点MI方面具有专业知识 解决酒精和性风险行为的交叉问题。此外，我们逐渐认识到， 多目标短期干预的科学，其中共同发生的风险行为可以干预， 他们的互惠关系被利用。特别是，我们有概念数据证明支持多个 有针对性的MI，结果表明减少酒精可以进一步降低性风险 行为我们还证明了使用电视会议在后勤方面的可行性和可接受性 在需求密集型环境中提供多目标管理信息技术。该提案利用我们的专业知识， 提供一种新的，多目标的视频会议MI（vMI），以种族多样化的PLWH在市中心的设置。 从翻译的角度来看，过程研究是一种新的信息干预手段 特别是在干预措施简短和有多个目标的情况下。例如当 制定一项具有两个交叉目标的干预措施，必须检查理想的显著性 和这些目标的测序。在第一阶段，我们将对现有的治疗过程进行新的分析 数据，以专门检查行为目标的显着性和序列作为短期MI结果的预测因素 已知其在影响多种风险行为方面具有功效。结果将使我们能够优化显着性， 在我们新的多目标MI中对酒精和坚持目标进行排序， 高危ART非依从患者。第一阶段将把过程研究转化为治疗开发 框架来优化多目标vMI，以减少消耗并提高依从性。二期将 检查多靶点vMI在双重风险PLWH中减少消耗和增加依从性的功效。

Abstract People living with HIV (PLWH) experience increased risk for all-cause mortality at lower levels of alcohol consumption compared to uninfected individuals and higher levels of alcohol-related problems are found among African Americans despite equivalent or lower drinking. Furthermore, deleterious effects of alcohol on ART adherence and clinical outcomes have been reported in low income urban populations. Moreover, it is recommended that PLWH receive routine alcohol screening, and that evidence-based brief motivational interventions (MI) be employed when they screen positive. Indeed, MI is well-established as efficacious in reducing consumption in a broad range of patients, and adherence-focused MI has been shown to improve adherence among PLWH. While evidence supporting extended interventions targeting both alcohol and adherence is promising, multi-session interventions are generally difficult to implement with high-risk patients and no study has evaluated a single-session MI targeting both. In many HIV settings, there are barriers preventing implementation of even brief MI, such as competing intensive demands, limited resources, and lack of alcohol-specific expertise. Telehealth technology offers a viable solution. Our team has expertise in developing efficacious alcohol-focused MIs and in multi-target MI addressing the intersection of alcohol and sexual risk behavior. Further, we have an emerging understanding of the science of multi-targeted brief intervention, where co-occurring risk behaviors can be intervened upon and their reciprocal associations exploited. In particular, we have proof of concept data supporting a multi- target MI with findings demonstrating reduction in alcohol can further contribute to reductions in sexual risk behavior. We have also demonstrated logistical feasibility and acceptability of using video-conferencing technology to deliver multi-target MI in a demand-intensive setting. This proposal leverages our expertise to deliver a novel, multi-target video-conferenced MI (vMI) to racially diverse PLWH in an inner-city setting. From a translational perspective, process research is a novel means of informing intervention development, particularly when interventions are brief and there are multiple targets. For example, when developing an intervention with 2 intersecting targets for change, it is imperative to examine the ideal salience and sequencing of these targets. In Phase I, we will conduct new analyses on existing therapeutic process data to specifically examine behavioral target salience and sequencing as predictors of outcome in a brief MI with known efficacy in affecting multiple risk behaviors. Results will allow us to optimize salience and sequencing of alcohol and adherence targets in our new multi-target MI developed specifically for reaching high-risk ART non-adherent patients. Phase 1 will translate process research into a treatment-development framework to optimize a multi-target vMI to reduce consumption and increase adherence. Phase II will examine efficacy of a multi-target vMI to reduce consumption and increase adherence among dual-risk PLWH.