背景:不健康的饮酒与艾滋病毒和结核病(TB)患者的发病率和死亡率增加有关。基于计算机的干预(CBIs)可以减少不健康的酒精使用,是可扩展的,并可能改善HIV或TB患者的预后。
目的:我们评估了可接受性,适应性,以及在浦那的HIV和TB临床环境中减少酒精的新型CBI的可行性,印度。
方法:我们对酒精使用障碍(AUD):TB(6/10)的患者进行了10次深入访谈,HIV(2/10)或使用便利抽样方法选择的HIV-TB合并感染(1/10),没有艾滋病毒或结核病(1/10),1焦点小组成员戒酒匿名(AA;n=12),和2个来自三级医院的医疗保健提供者(HCP)的焦点小组(n=22)。所有参与者都对3D虚拟顾问提供的AUDCBI进行了审查并提供了反馈。使用结构化框架分析对定性数据进行分析。
结果:大多数(9/10)的深度访谈受访者是男性,平均年龄42岁(IQR38-45岁)。AA焦点组参与者均为男性(12/12),和HCP焦点组参与者主要是女性(n=15)。反馈被组织成3个领域:(1)虚拟辅导员的可接受性,(2)干预适应性,(3)CBI干预在临床环境中的可行性。总的来说,深入访谈的参与者发现虚拟顾问是可以接受的,并且诚实地回答与酒精有关的问题感到舒适。所有焦点小组的参与者都更喜欢人类虚拟辅导员,而不是动物虚拟辅导员,以便潜在地增加CBI的参与度。此外,通过提供更灵活的互动,与现场人类辅导员的互动将进一步增强该计划的有效性。HCP焦点小组参与者注意到增加酒精对HIV和TB结局影响的信息的重要性,因为患者没有被视为理解这些联系。对于本地适应,关于酒精饮料类型的更多信息,额外的饮酒诱因,动机,所有焦点小组参与者都建议开展替代饮酒的活动.干预持续时间(约20分钟)和速度被认为是适当的。HCP报告说,CBI提供了系统的,标准化咨询。所有焦点小组和深度访谈参与者都报告说,在HIV或TB计划人员的帮助下,CBI可以在印度临床环境中实施。
结论:在印度临床护理机构中,针对HIV和TB患者的文化量身定制,虚拟顾问提供的酒精干预是可以接受的,并且似乎可以实施,特别是如果再加上个人提供的咨询。
BACKGROUND: Unhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) 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 with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis.
RESULTS: The majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group 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 focus group participants 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 focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the 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 and appears feasible to implement, particularly if coupled with person-delivered counseling.