Abstract
ObjectiveAddressing alcohol use in primary HIV settings can improve medical outcomes and overall quality of life of persons living with HIV (PLWH). In order to assess the feasibility of computer-delivered brief alcohol intervention (CBI) and to inform future efforts to improve access to CBI, we examined patient-level socio-demographic, clinical and behavioral characteristics associated with agreement to participate in CBI among non-treatment seeking PLWH with alcohol misuse.MethodsParticipants were recruited from two Centres for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics. PLWH completed a clinical assessment of patient-reported measures and outcomes using tablet-based assessments, including socio-demographic and behavioural characteristics. HIV biological indicators, i.e., CD4 count and viral load, were also available from the electronic medical record. Participants were approached for CBI participation based on scores on the Alcohol Use Disorders Identification Test (AUDIT); no incentives were offered for CBI participation. We performed chi-square tests, analysis of variance and multivariate logistic regression to compare socio-demographic, behavioural and clinical factors among participants who agreed to participate compared with those who refused/postponed participation.ResultsWe observed that 42% of non-treatment seeking, non-incentivized PLWH with alcohol misuse provided written agreement to participate in on-site CBI delivered in their HIV primary care clinic. A larger proportion of PLWH who agreed to enrol in CBI had detectable viral loads, heavier weekly alcohol use, and higher DSM-5 alcohol use disorder symptom counts and mental health symptoms. Neither socio-demographic background nor drug use status was associated with CBI enrolment.ConclusionCBI implementation reached those patients most in need of care. The findings of this study may assist HIV-care providers to better identify appropriate patients and initiate discussions to facilitate the participation of PLWH in alcohol intervention services.
Highlights
IntroductionPrevalence of alcohol misuse (heavy/binge drinking and alcohol use disorder) is elevated among persons living with HIV (PLWH) compared with the general population [1,2,3]
Prevalence of alcohol misuse is elevated among persons living with HIV (PLWH) compared with the general population [1,2,3]
We observed that 42% of non-treatment seeking, non-incentivized PLWH with alcohol misuse provided written agreement to participate in on-site computer-delivered brief alcohol intervention (CBI) delivered in their HIV primary care clinic
Summary
Prevalence of alcohol misuse (heavy/binge drinking and alcohol use disorder) is elevated among persons living with HIV (PLWH) compared with the general population [1,2,3]. Given the deleterious relationship between alcohol misuse, HIV transmission and outcomes, addressing alcohol use in HIV primary care settings is essential to improve the overall quality of life and long-term medical outcomes of PLWH. Despite considerable efforts to encourage providers to adopt BI in practice, various implementation barriers exist in primary healthcare settings, including a reluctance of patients to disclose alcohol misuse to their healthcare providers, limited financial resources in clinics, and a significant time commitment from providers [7]
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