Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA.
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
Addict Sci Clin Pract. 2019 Jun 7;14(1):21. doi: 10.1186/s13722-019-0150-8.
HIV care providers often serve as the specialist and the primary care point-of-contact for persons living with HIV (PLWH) and unhealthy alcohol use. The purpose of the present qualitative study was to understand HIV care provider perceptions and approaches to managing unhealthy alcohol use in HIV primary care settings.
Using a semi-structured interview guide, in-depth interviews were conducted among 14 HIV care providers (5 medical doctors, 5 nurse practitioners/physician assistants, 2 medical assistants, 2 clinical administrative staff) in private and public HIV clinics, across urban and rural areas of Florida. Interviews were coded using a grounded theory approach with inter-rater consensus.
Six themes were identified. In summary, providers reported (1) inconsistent assessment of alcohol consumption, as well as (2) varying levels of confidence in self-report of alcohol use which may be affected by patient provider rapport and trust. While providers (3) acknowledge potential negative impacts of alcohol use on health outcomes and HIV treatment, providers reported (4) inconsistent recommendations regarding alcohol use among their patients. Lastly, providers reported (5) limited resources for patients with unhealthy alcohol use and (6) low confidence in their ability to help patients reduce use.
Results from our study suggest salient differences in provider approaches to the assessment and management of unhealthy alcohol use in HIV primary care settings. Implementation of care for unhealthy alcohol use in these settings may be facilitated through use of clinically useful, validated alcohol use assessments and use of evidence-based recommendations of alcohol use/non-use among PLWH. Training in brief intervention techniques for alcohol reduction may increase provider confidence and support in the management of unhealthy alcohol use among PLWH.
艾滋病毒护理提供者通常是艾滋病毒感染者（PLWH）和不健康饮酒者的专科医生和初级保健联系点。本定性研究的目的是了解艾滋病毒护理提供者对管理艾滋病毒初级保健环境中不健康饮酒的看法和方法。
在佛罗里达州的城市和农村地区的私人和公共艾滋病毒诊所中，使用半结构化访谈指南对 14 名艾滋病毒护理提供者（5 名医生、5 名护士执业医师/医师助理、2 名医疗助理、2 名临床行政人员）进行了深入访谈。访谈使用扎根理论方法进行编码，并达成了共识。
确定了六个主题。总之，提供者报告（1）对酒精消耗的评估不一致，以及（2）对自我报告的酒精使用的信心程度不同，这可能会受到患者与提供者的融洽关系和信任的影响。虽然提供者（3）承认酒精使用对健康结果和 HIV 治疗的潜在负面影响，但提供者报告（4）对其患者的酒精使用建议不一致。最后，提供者报告（5）为有不健康饮酒习惯的患者提供的资源有限，（6）对帮助患者减少使用的能力缺乏信心。
我们的研究结果表明，提供者在艾滋病毒初级保健环境中评估和管理不健康饮酒的方法存在明显差异。通过使用临床有用的、经过验证的酒精使用评估以及在 PLWH 中使用关于酒精使用/不使用的循证建议，可以促进在这些环境中为不健康酒精使用提供护理。对酒精减少的简短干预技术的培训可以提高提供者对管理 PLWH 中不健康酒精使用的信心和支持。
