Abstract
BackgroundHIV 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.MethodsUsing 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.ResultsSix 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.ConclusionsResults 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.
Highlights
Among persons living with human immunodeficiency virus (HIV) (PLWH), unhealthy alcohol use, ranging from at-risk use [> 14 (7) drinks per week for men], binge drinking [> 4 (3) standard drinks on one occasion in men] to alcohol use disorder (AUD) [1], is associated with lower adherence to antiretroviral therapy (ART), compared to abstinence [2]
In order to gain an understanding of the collective perspective on care for unhealthy alcohol use in HIV primary care settings, we sought a diverse group of HIV care providers within all levels of the HIV care cascade, including medical doctors, registered nurse practitioners, physician assistants, medical assistants and clinic administrative staff who have worked with PLWH for at least 1 year
A combination of convenience and snowball sampling was used to recruit providers–providers affiliated with the Southern HIV and Alcohol Research Consortium (SHARC), a center located within the University of Florida Department of Epidemiology examining determinants of health outcomes of PLWH within the state for Florida, were contacted with information about the study and asked to suggest alternative providers who may be interested in participating
Summary
Among persons living with HIV (PLWH), unhealthy alcohol use, ranging from at-risk use [> 14 (7) drinks per week for men (women)], binge drinking [> 4 (3) standard drinks on one occasion in men (women)] to alcohol use disorder (AUD) [1], is associated with lower adherence to antiretroviral therapy (ART), compared to abstinence [2]. 10–30% of PLWH receiving services at HIV primary care clinics report unhealthy alcohol use [3, 4] and up to 19% meet criteria for AUD [5]. Aside from effects on HIV care and disease progression, unhealthy alcohol use is associated with greater risk for cardiovascular disease [16,17,18], non-AIDS defining cancers [19], neurologic disorders [20,21,22], and reduced life expectancy [23,24,25,26,27]. Knowledge regarding effective assessment of and intervention for unhealthy alcohol use among HIV-care providers remains a concern. 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
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