Cohen Shawn M, DePhilippis Dominick, Deng Yanhong, Dziura James, Ferguson Tekeda, Fucito Lisa M, Justice Amy C, Maisto Stephen, Marconi Vincent C, Molina Patricia, Paris Manuel, Rodriguez-Barradas Maria C, Simberkoff Michael, Petry Nancy M, Fiellin David A, Edelman E Jennifer
Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Alcohol Clin Exp Res (Hoboken). 2023 Sep;47(9):1783-1797. doi: 10.1111/acer.15159. Epub 2023 Aug 29.
Contingency management (CM) is an evidence-based approach for reducing alcohol use; however, its implementation into routine HIV primary care-based settings has been limited. We evaluated perspectives on implementing CM to address unhealthy alcohol use and associated conditions for people with HIV in primary care settings.
From May 2021 to August 2021, we conducted two focus groups with staff involved in delivering the intervention (n = 5 Social Workers and n = 4 Research Coordinators) and individual interviews (n = 13) with a subset of participants involved in the multi-site Financial Incentives, Randomization, and Stepped Treatment (FIRST) trial. Qualitative data collection and analyses were informed by the Promoting Action on Research Implementation in Health Service (PARIHS) implementation science framework, including evidence (perception of CM), context (HIV primary care clinic and CM procedures), and facilitation (feasibility outside the research setting).
Several major themes were identified. Regarding the evidence, participants lacked prior experience with CM, but the intervention was well received and, by some, perceived to lead to lasting behavior change. Regarding the clinical context for the reward schedule, the use of biochemical testing, specifically fingerstick phosphatidylethanol testing, and the reward process were perceived to be engaging and gratifying for both staff and patients. Participants indicated that the intervention was enhanced by its co-location within the HIV clinic. Regarding facilitation, participants suggested addressing the intervention's feasibility for non-research use, simplifying the reward structure, and rewarding non-abstinence in alcohol use.
Among patients and staff involved in a clinical trial, CM was viewed as a helpful, positive, and feasible approach to addressing unhealthy alcohol use and related conditions. To enhance implementation, future efforts may consider simplified approaches to the reward structure and expanding rewards to non-abstinent reductions in alcohol consumption.
应急管理（CM）是一种基于证据的减少酒精使用的方法；然而，其在基于常规HIV初级保健的环境中的实施一直有限。我们评估了在初级保健环境中实施CM以解决HIV感染者不健康饮酒及相关状况的观点。
2021年5月至2021年8月，我们对参与实施干预措施的工作人员进行了两次焦点小组访谈（5名社会工作者和4名研究协调员），并对参与多中心财务激励、随机化和阶梯式治疗（FIRST）试验的部分参与者进行了个人访谈（13人）。定性数据的收集和分析以卫生服务研究实施促进行动（PARIHS）实施科学框架为依据，包括证据（对CM的认知）、背景（HIV初级保健诊所和CM程序）以及促进因素（研究环境之外的可行性）。
确定了几个主要主题。关于证据，参与者此前缺乏CM经验，但该干预措施受到好评，一些人认为它能带来持久的行为改变。关于奖励计划的临床背景，生物化学检测（特别是指尖磷脂酰乙醇检测）的使用以及奖励过程被认为对工作人员和患者都有吸引力且令人满意。参与者表示，该干预措施因在HIV诊所内实施而得到加强。关于促进因素，参与者建议解决该干预措施在非研究用途方面的可行性，简化奖励结构，并对减少饮酒但未戒酒的情况给予奖励。
在参与一项临床试验的患者和工作人员中，CM被视为解决不健康饮酒及相关状况的一种有益、积极且可行的方法。为加强实施，未来的努力可考虑简化奖励结构的方法，并将奖励扩大到减少饮酒但未戒酒的情况。
