Abstract
Hazardous and heavy alcohol use is common among people living with HIV and may decrease antiretroviral therapy (ART) adherence, but limited data exist from randomized clinical trials about the effects of interventions on viral load. To compare the efficacy of 2 scalable ART clinic-based interventions on alcohol use and viral suppression. This 3-group randomized clinical trial was conducted among 440 adults with HIV who were being treated at 7 ART clinics in Thai Nguyen, Vietnam. Adults receiving ART with hazardous alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥4 for men or ≥3 for women) and no plans to leave Thai Nguyen were included. Data were collected from March 2016 to May 2018 and analyzed from June 2018 to February 2020. Participants were randomly assigned (1:1:1) to standard of care (SOC), a combined intervention of motivational enhancement therapy and cognitive behavioral therapy (6 in-person sessions of 1 hour each and 3 optional group sessions), or a brief intervention with similar components as the combined intervention but consisting of 2 shorter in-person sessions and 2 telephone sessions. The primary study outcomes were percentage of days abstinent from alcohol, confirmed using the alcohol biomarker phosphatidylethanol, and viral suppression at 12 months after enrollment. A total of 440 eligible individuals (mean [SD] age, 40.2 [5.8] years; 426 [96.8%] men) were enrolled; 147 (33.4%) were assigned to the combined intervention, 147 (33.4%) to the brief intervention, and 146 (33.2%) to SOC. In the combined intervention group, 112 participants (76.2%) attended all 6 sessions, and in the brief intervention group, 124 (84.4%) attended all 4 sessions; in the whole sample, 390 (88.6%) completed 12 months of follow-up. At 12 months, the mean (SE) percentage of days abstinent was 65% (3.1%) among those in the combined intervention group, 65% (3.2%) among those in the brief intervention group, and 50% (3.4%) among those in the in the SOC group (Cohen d for combined intervention vs SOC and brief intervention vs SOC: 39%; 95% CI, 15% to 64%). Viral suppression (ie, <20 copies of HIV-1 RNA per milliliter) at 12 months was higher after the brief intervention than SOC (difference, 11%; 95% CI, 2% to 20%), but the difference between the combined intervention and SOC was not significantly different (difference, 5%; 95%, CI, -5% to 15%). In this study, the brief intervention resulted in a significant increase in percentage of days abstinent from alcohol and a significant increase in viral suppression after 12 months. Future implementation science studies evaluating scale-up of the brief intervention are needed. ClinicalTrials.gov Identifier: NCT02720237.
Highlights
Hazardous alcohol use is highly prevalent among people living with HIV (PWH).[1]
At 12 months, the mean (SE) percentage of days abstinent was 65% (3.1%) among those in the combined intervention group, 65% (3.2%) among those in the brief intervention group, and 50% (3.4%) among those in the in the standard of care (SOC) group (Cohen d for combined intervention vs SOC and brief intervention vs SOC: 39%; 95% CI, 15% to 64%)
Viral suppression at 12 months was higher after the brief intervention than SOC, but the difference between the combined intervention and SOC was not significantly different
Summary
Hazardous alcohol use is highly prevalent among people living with HIV (PWH).[1] In a large multisite clinical cohort of PWH in the United States, 27% reported hazardous alcohol use and 34% reported binge drinking.[2] In low-income and middle-income countries, hazardous alcohol use among PWH is common, with 20% to 46% of PWH reporting hazardous alcohol use.[3,4,5,6,7,8,9] Alcohol use has been associated with decreased adherence to antiretroviral therapy (ART)[10,11,12] and decreased viral suppression.[13] Alcohol use is associated with elevated sexual and injection risk behaviors that increase the likelihood of HIV transmission.[7,14,15,16] Despite the known adverse health consequences of alcohol use, there is a lack of evidence-based interventions for PWH,[17,18,19,20,21] and hazardous and heavy alcohol consumption are frequently not addressed in HIV health care settings
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