Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, 02215, USA.
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA, USA.
Addict Sci Clin Pract. 2019 Aug 29;14(1):35. doi: 10.1186/s13722-019-0165-1.
Chronic pain and heavy drinking commonly co-occur and can influence the course of HIV. There have been no interventions designed to address both of these conditions among people living with HIV (PLWH), and none that have used telehealth methods. The purpose of this study was to better understand pain symptoms, patterns of alcohol use, treatment experiences, and technology use among PLWH in order to tailor a telehealth intervention that addresses these conditions.
Ten participants with moderate or greater chronic pain and heavy drinking were recruited from a cohort of patients engaged in HIV-care (Boston Alcohol Research Collaborative on HIV/AIDS Cohort) and from an integrated HIV/primary care clinic at a large urban hospital.
One-on-one interviews were conducted with participants to understand experiences and treatment of HIV, chronic pain, and alcohol use. Participants' perceptions of the influence of alcohol on HIV and chronic pain were explored as was motivation to change drinking. Technology use and treatment preferences were examined in the final section of the interview. Interviews were recorded, transcribed and uploaded into NVivo v12 software for analysis. A codebook was developed based on interviews followed by thematic analysis in which specific meanings were assigned to codes. Interviews were supplemented with Likert-response items to evaluate components of the proposed intervention.
A number of themes were identified that had implications for intervention tailoring including: resilience in coping with HIV; autonomy in health care decision-making; coping with pain, stress, and emotion; understanding treatment rationale; depression and social withdrawal; motives to drink and refrain from drinking; technology use and capacity; and preference for intervention structure and style. Ratings of intervention components indicated that participants viewed each of the proposed intervention content areas as "helpful" to "very helpful". Videoconferencing was viewed as an acceptable modality for intervention delivery.
Results helped specify treatment targets and provided information about how to enhance intervention delivery. The interviews supported the view that videoconferencing is an acceptable telehealth method of addressing chronic pain and heavy drinking among PLWH.
慢性疼痛和重度饮酒通常同时发生，并可能影响 HIV 的病程。目前还没有针对 HIV 感染者（PLWH）同时解决这两种情况的干预措施，也没有使用远程医疗方法的干预措施。本研究的目的是更好地了解 PLWH 的疼痛症状、饮酒模式、治疗经验和技术使用情况，以便针对这些情况定制远程医疗干预措施。
从参与 HIV 护理的患者队列（波士顿艾滋病研究协作组）和一家大型城市医院的综合 HIV/初级保健诊所中招募了 10 名患有中度或重度慢性疼痛和重度饮酒的参与者。
对参与者进行一对一访谈，以了解他们在 HIV、慢性疼痛和饮酒方面的经历和治疗情况。探讨了参与者对酒精对 HIV 和慢性疼痛影响的看法，以及改变饮酒习惯的动机。在访谈的最后一部分，还检查了技术使用和治疗偏好。访谈记录、转录并上传到 NVivo v12 软件中进行分析。根据访谈内容制定了一个代码本，然后进行主题分析，为代码分配特定含义。访谈内容还辅以李克特反应项，以评估拟议干预措施的组成部分。
确定了一些主题，这些主题对干预措施的定制具有重要意义，包括：应对 HIV 的韧性；医疗决策的自主权；应对疼痛、压力和情绪；理解治疗原理；抑郁和社交退缩；饮酒和戒酒的动机；技术使用和能力；以及对干预结构和风格的偏好。对干预组成部分的评分表明，参与者认为每个拟议的干预内容领域都“有帮助”到“非常有帮助”。视频会议被视为一种可接受的干预传递方式。
结果有助于确定治疗目标，并提供有关如何增强干预效果的信息。访谈结果支持了这样一种观点，即视频会议是一种可接受的远程医疗方法，可以解决 PLWH 的慢性疼痛和重度饮酒问题。
