Abstract
Alcohol use disorders (AUDs) are highly prevalent among people living with HIV/AIDS (PLWHA) and are associated with increased HIV risk behaviors, suboptimal treatment adherence, and greater risk for disease progression. We used the ADAPT-ITT strategy to adapt an evidence-based intervention (EBI), the Holistic Health Recovery Program (HHRP+), that focuses on secondary HIV prevention and antiretroviral therapy (ART) adherence and apply it to PLWHA with problematic drinking. Focus groups (FGs) were conducted with PLWHA who consume alcohol and with treatment providers at the largest HIV primary care clinic in New Orleans, LA. Overall themes that emerged from the FGs included the following: (1) negative mood states contribute to heavy alcohol consumption in PLWHA; (2) high levels of psychosocial stress, paired with few adaptive coping strategies, perpetuate the use of harmful alcohol consumption in PLWHA; (3) local cultural norms are related to the permissiveness and pervasiveness of drinking and contribute to heavy alcohol use; (4) healthcare providers unanimously stated that outpatient options for AUD intervention are scarce, (5) misperceptions about the relationships between alcohol and HIV are common; (6) PLWHA are interested in learning about alcohol's impact on ART and HIV disease progression. These data were used to design the adapted EBI.
Highlights
Alcohol consumption, especially among individuals with alcohol use disorders (AUDs), is independently associated with sexual HIV risk and with HIV transmission [1, 2]
(11) Do you regularly discuss alcohol use with your patients? If so, how often? (12) Is discussing alcohol use difficult to navigate as a provider? (13) What HIV prevention approaches do you use ? How well do they work? Are there any improvements that could be made that would make them more effective? (14) What has worked best to decrease substance abuse or to elicit other behavioral changes like HIV risk reduction with your patients? What has been tried that was not successful?
Results from our focus groups suggest that addressing alcohol use in People living with HIV/AIDS (PLWHA) should involve a brief and targeted harm reduction intervention that can be delivered in a primary care setting with optimal accessibility to the target population
Summary
Especially among individuals with alcohol use disorders (AUDs), is independently associated with sexual HIV risk and with HIV transmission [1, 2]. Though there are conflicting findings from studies using various study designs [9], alcohol consumption is associated with ART medication nonpersistence and nonadherence [10,11,12]. Drinking [11, 13] or having a treatable AUD [14] is independently associated with ART nonadherence. While ART has significantly decreased morbidity and mortality from HIV [15], many alcohol-using patients do not achieve the recommended 95% adherence level necessary to maintain viral suppression and the prevention of the development of a resistant virus [16,17,18,19]
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