Abstract
BackgroundAt-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use.MethodsIn this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol consumption of ≥ 14 drinks per week or ≥ 4 drinks per occasion in men ≤ 65 years old or ≥ 7 drinks per week or ≥ 3 drinks per occasion in women or men > 65 years old]. ISAT (n = 46) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 47) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat principles.ResultsDespite a multi-pronged approach, we only recruited 37% of the target population (n = 93/254). Among ISAT participants, 50% advanced to Step 2, among whom 57% advanced to Step 3. Participants randomized to ISAT and TAU had no observed difference in drinks per week over the past 30 days at week 24 (primary outcome) [least square means (Ls mean) (95% CI) = 8.8 vs. 10.6; adjusted mean difference (AMD) (95% CI) = − 0.4 (− 3.9, 3.0)].ConclusionAn insufficient number of patients were interested in participating in the trial. Efforts to enhance motivation of PWH with at-risk alcohol use to engage in alcohol-related research and build upon ISAT are needed.Trial registration Clinicaltrials.gov: NCT01410123, First posted August 4, 2011
Highlights
At-risk levels of alcohol use threaten the health of patients with Health Administration (VA) Infectious Disease (HIV) (PWH), yet evidence-based strate‐ gies to decrease alcohol use and improve HIV-related outcomes in this population are lacking
The aims of this study were to examine the effectiveness of integrated stepped alcohol treatment (ISAT) versus treatment as usual (TAU) on alcohol use and HIV outcomes among patients with HIV (PWH) with at-risk alcohol use
We hypothesized that ISAT would be associated with improved drinking and health outcomes compared to TAU, with the primary hypothesis being that ISAT would lead to fewer drinks per week compared with TAU
Summary
At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strate‐ gies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. Despite its potential to improve individual and public health, brief intervention with subsequent indicated treatment is inconsistently delivered to PWH [11], and, to date, only a limited number of studies have been designed to address unhealthy alcohol use (defined as the spectrum of alcohol use including at-risk drinking and alcohol use disorder) among PWH [12,13,14,15,16,17] These studies have generally focused on evaluation of a specific medication (i.e., naltrexone) [12] or behavioral intervention [13,14,15,16] and some focused on a specific patient population (e.g., women, men who have sex with men). We hypothesized that ISAT would be associated with improved drinking and health outcomes compared to TAU, with the primary hypothesis being that ISAT would lead to fewer drinks per week compared with TAU
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