A Novel Computer-Based Virtual Counselor-Delivered Alcohol Reduction Intervention: Acceptability, Adaptability and Feasibility among Adults with HIV or TB in Indian Clinical Settings (Preprint)

2021 ◽  
Author(s):  
Nishi Suryavanshi ◽  
Gauri Dhumal ◽  
Samyra Cox ◽  
Shashikala Sangle ◽  
Andrea DeLuca ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Health Care Providers ◽  
Clinical Care ◽  
Clinical Settings ◽  
Care Hospital ◽  
Care Providers ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol ◽  
Computer Based ◽  
Alcohol Reduction

BACKGROUND Unhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and/or TB. Computer-Based interventions (CBI) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB. OBJECTIVE We assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India. METHODS We conducted 10 in-depth interviews (IDIs) with persons with alcohol use disorder (AUD); [TB (n=6), HIV (n=2), HIV-TB co-infected (n=1) selected using convenience sampling method, No HIV or TB disease (n=1)], one focus group (FG) with members of alcoholics anonymous (AA) (n=12, and two FGs with health care providers (HCPs) of a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3-D virtual counselor. Qualitative data were analyzed using structured framework analysis. RESULTS Majority (n=9) of IDI respondents were male with median age 42 (IQR; 38-45) years. AA FG participants were all male (n=12) and HCPs FG participants were predominantly female (n=15). Feedback was organized into 3 domains: 1) Virtual counselor acceptability; 2) Intervention adaptability; and 3) feasibility of CBI intervention in clinic settings. Overall IDI participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All FG participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program’s effectiveness by providing more flexible interaction. HCP FGs noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators and activities to substitute for drinking alcohol were suggested by all FG participants. Intervention duration (~20 minutes) and pace were deemed appropriate. HCPs reported that CBI provides systematic, standardized counseling. All FG and IDI reported that CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff. CONCLUSIONS With cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor-delivered alcohol intervention is acceptable, appears feasible to implement, particularly if coupled with person-delivered counseling.

Treatment of Unhealthy Alcohol Use

2019 ◽  
Author(s):  
Stephen R Holt ◽  
David A Fiellin
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Behavioral Therapy ◽  
Primary Care Providers ◽  
Similar Efficacy ◽  
Motivational Enhancement Therapy ◽  
Behavioral Strategies ◽  
Care Providers ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

scholarly journals Computer-Based Alcohol Reduction Intervention for Alcohol-Using HIV/HCV Co-Infected Russian Women in Clinical Care: Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Ralph J. DiClemente ◽  
Jennifer L. Brown ◽  
Ariadna Capasso ◽  
Natalia Revzina ◽  
Jessica M. Sales ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Disease Progression ◽  
Clinical Care ◽  
Standard Of Care ◽  
Ethyl Glucuronide ◽  
Intervention Efficacy ◽  
Computer Based ◽  
Alcohol Reduction

Abstract Background: Russia has a high prevalence of HIV. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with Hepatitis C virus (HCV); and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. In spite of the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care. Methods: In this two-arm parallel randomized clinical trial, we propose to evaluate the efficacy of a culturally-adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21-45 years old, with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG) and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence, and concealment of allocation techniques to minimize assignment bias. Women are randomized to either: (1) the computer-based alcohol reduction intervention, or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard-of-care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load, and CD4+ levels), and HCV markers of disease progression (FibroScan).Discussion: The proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants. The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated in clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis.Trial registration: ClinicalTrials.gov, NCT03362476. Registered 5 December 2017, https://clinicaltrials.gov/ct2/show/NCT03362476

Treatment of Unhealthy Alcohol Use

2019 ◽  
Author(s):  
Stephen R Holt ◽  
David A Fiellin
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Behavioral Therapy ◽  
Primary Care Providers ◽  
Similar Efficacy ◽  
Motivational Enhancement Therapy ◽  
Behavioral Strategies ◽  
Care Providers ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

Treatment of Unhealthy Alcohol Use

2019 ◽  
Author(s):  
Stephen R Holt ◽  
David A Fiellin
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Behavioral Therapy ◽  
Primary Care Providers ◽  
Similar Efficacy ◽  
Motivational Enhancement Therapy ◽  
Behavioral Strategies ◽  
Care Providers ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol

Unhealthy alcohol use represents the fifth leading cause of morbidity and mortality globally, and the first leading cause among persons 18 to 45 years of age. Despite the global impact of unhealthy alcohol use, the adoption of evidence-based treatments has been sluggish. Behavioral strategies for lower level drinking include the brief motivational interview, designed to be within the scope of any healthcare provider, and more specialist-driven approaches for those with alcohol use disorder (AUD) such as cognitive behavioral therapy and motivational enhancement therapy. Benzodiazepines remain the mainstay treatment for inpatient alcohol withdrawal treatment, whereas other medications have similar efficacy in managing patients in the outpatient setting with milder forms of withdrawal. For maintenance treatment of AUD, four FDA-approved medications exist, with efficacy in treating AUD, as well as several non–FDA-approved medications that have been found to be effective in promoting abstinence and reducing drinking. The use of medication to treat many patients with AUD falls within the scope of primary care providers. This review contains 6 tables and 54 references. Key Words: addiction, alcohol, counseling, drinking, pharmacotherapy, primary care, psychotherapy, relapse, treatment

scholarly journals Computer-based alcohol reduction intervention for alcohol-using HIV/HCV co-infected Russian women in clinical care: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ralph J. DiClemente ◽  
Jennifer L. Brown ◽  
Ariadna Capasso ◽  
Natalia Revzina ◽  
Jessica M. Sales ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Controlled Trial ◽  
Clinical Care ◽  
Standard Of Care ◽  
Randomized Controlled ◽  
Intervention Efficacy ◽  
Computer Based ◽  
Alcohol Reduction

Abstract Background Russia has a high prevalence of human immunodeficiency virus (HIV) infections. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with hepatitis C virus (HCV), and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. Despite the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care. Methods In this two-arm parallel randomized controlled trial, we propose to evaluate the efficacy of a culturally adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21–45 years old with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG), and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence and concealment of allocation techniques to minimize assignment bias. Women are randomized to either (1) the computer-based alcohol reduction intervention or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard of care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load and CD4+ levels) and HCV markers of disease progression (FibroScan). Discussion The proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants. The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated into clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis. Trial registration ClinicalTrials.gov NCT03362476. Registered on 5 December 2017

Communication and psychological safety in veterans health administration work environments

2014 ◽  
Vol 28 (6) ◽  
pp. 754-776 ◽  
Author(s):  
Nancy J. Yanchus ◽  
Ryan Derickson ◽  
Scott C. Moore ◽  
Daniele Bologna ◽  
Katerine Osatuke
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychological Safety ◽  
Veterans Health Administration ◽  
Employee Perceptions ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Content Type

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

Sign in / Sign up

Export Citation Format

Share Document