Interventions Targeting Alcohol Use Research Articles

Analyzing Dropout in Alcohol Recovery Programs: A Machine Learning Approach.

Background: Retention in treatment is crucial for the success of interventions targeting alcohol use disorder (AUD), which affects over 100 million people globally. Most previous studies have used classical statistical techniques to predict treatment dropout, and their results remain inconclusive. This study aimed to use novel machine learning tools to identify models that predict dropout with greater precision, enabling the development of better retention strategies for those at higher risk. Methods: A retrospective observational study of 39,030 (17.3% female) participants enrolled in outpatient-based treatment for alcohol use disorder in a state-wide public treatment network has been used. Participants were recruited between 1 January 2015 and 31 December 2019. We applied different machine learning algorithms to create models that allow one to predict the premature cessation of treatment (dropout). With the objective of increasing the explainability of those models with the best precision, considered as black-box models, explainability technique analyses were also applied. Results: Considering as the best models those obtained with one of the so-called black-box models (support vector classifier (SVC)), the results from the best model, from the explainability perspective, showed that the variables that showed greater explanatory capacity for treatment dropout are previous drug use as well as psychiatric comorbidity. Among these variables, those of having undergone previous opioid substitution treatment and receiving coordinated psychiatric care in mental health services showed the greatest capacity for predicting dropout. Conclusions: By using novel machine learning techniques on a large representative sample of patients enrolled in alcohol use disorder treatment, we have identified several machine learning models that help in predicting a higher risk of treatment dropout. Previous treatment for other substance use disorders (SUDs) and concurrent psychiatric comorbidity were the best predictors of dropout, and patients showing these characteristics may need more intensive or complementary interventions to benefit from treatment.

Food and alcohol disturbance, alcohol use, and negative consequences among college students engaging in binge drinking: A longitudinal examination of between- and within-person effects.

Researchers have documented robust associations between food and alcohol disturbance (FAD-intoxication; restricting caloric intake before or during alcohol consumption to experience a quicker and/or more intense alcohol intoxication) and alcohol use and related negative consequences. However, most of this research has utilized cross-sectional designs. Consequently, two crucial gaps have not yet been filled: (a) the separation of the relatively stable, between-person and the fluctuating, within-person components in the relations between FAD-intoxication and alcohol-related constructs; and (b) the examination of the directionality of these within-person relations. Participants were college students (n = 686) who reported past-month binge drinking. Most participants identified as White (71.3%), female (78.4%), non-Hispanic (87.8%), with a mean age of 20.64 (SD = 3.25). Participants completed three online surveys assessing FAD-intoxication (College Eating and Drinking Behaviors Scale), alcohol use (Daily Drinking Questionnaire), and related negative consequences (Brief Young Adult Alcohol Consequences Questionnaire). Analyses revealed that FAD-intoxication was positively associated with alcohol use and related negative consequences at the between-person level. Additionally, at the within-person level, FAD-intoxication at Time 2 significantly predicted alcohol use at Time 3. Notably, the cross-lagged effect from FAD-intoxication at Time 1 to alcohol use at Time 2 was not significant. FAD-intoxication did not significantly predict negative consequences. Neither use nor consequences significantly predicted FAD-intoxication. Our results suggest that FAD-intoxication is relevant to the study of alcohol use and related negative consequences and should be considered in interventions targeting alcohol use and related negative consequences among students who endorse binge drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interventions in the workplace to reduce risk factors for noncommunicable diseases: an umbrella review of systematic reviews of effectiveness.

Workplaces are an important setting to deliver programs to reduce risk factors for noncommunicable diseases (NCDs). To help decision makers understand the most current and relevant evidence regarding effectiveness of workplace programs, we conducted an umbrella review to present a comprehensive synthesis of the large volume of literature. Systematic reviews of workplace interventions targeting primary risk factors for NCDs-unhealthy diet, insufficient physical activity, overweight/obesity, tobacco use, and/or excessive alcohol use-published since 2010 were sourced. For each risk factor, reviews were categorized by intervention type and quality. The most recent, high-quality review was included for each intervention type. Evidence for the effectiveness of each intervention type was then broadly classified based on the review summary findings. Twenty-one reviews were included. Most reviews focused on diet (n = 5), physical activity (n = 7), or obesity (n = 9) interventions, with fewer targeting alcohol (n = 2) or tobacco (n = 2) use. Reviews of interventions focusing on individual behavior (such as education or counseling) were most common. Across diet, obesity, physical activity, and tobacco use, multicomponent interventions were consistently likely to be classified as "likely effective." Motivational interviewing and broad health promotion interventions were identified as "promising" for alcohol use. This umbrella review identified that multicomponent workplace interventions were effective to reduce NCD risk factors. There is a gap around interventions targeting alcohol use as most syntheses lacked enough studies to draw conclusions about effectiveness. Exploring the impact of interventions that utilize policy and/or environmental strategies is a critical gap for future research.

Stakeholder-Informed Solutions To Address Barriers for Alcohol Screening and Brief Intervention in Thai Hypertension Care.

Premature deaths from NCDs disproportionately affect people in low- and middle-income countries. Since alcohol use is one of the most common causes of reversible hypertension, interventions targeting alcohol use may be a feasible and effective low-cost approach to synergistically reduce the prevalence of harmful drinking and high blood pressure. This study sought to identify key factors in successfully implementing alcohol use screening and brief intervention in hypertension care in Thailand. For this purpose, we surveyed participants (NRound 1 = 91, NRound 2 = 27) from three different groups of Thai stakeholders (policy- and decisionmakers, primary healthcare practitioners, and patients diagnosed with hypertension) in a two-round stakeholder elicitation. In round 1, we identified limited resources, lack of clear guidelines for lifestyle intervention, stigmatization, and inconsistent monitoring of patients' alcohol use as important barriers. In round 2, we sought to elicit solutions for the barriers identified in round 1. While stakeholders emphasized the need for adaptability to existing realities in Thai primary healthcare such as a high workload and limited digitization, they favorably evaluated a digital alcohol assessment tool with integrated, tailored advice for brief intervention as a potential scalable solution. Findings suggest that as one possible route to reduce the NCD burden caused by hypertension in Thailand, primary healthcare services may be enhanced by digital tools that support resource-effective, intuitive, and seamless delivery of alcohol screening and brief intervention.

Professionals’ views on interventions to reduce and prevent problematic alcohol use in older adults

Abstract Background Interventions to address problematic alcohol use in older adults are needed as alcohol use is highly prevalent among those over 55 years of age. For interventions to be most effective, their working elements should be leveraged. However, understanding of working elements specifically in interventions for older adults is limited. The aim of this study was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol use among older adults, from the perspective of professionals providing these interventions. Methods Guided by a Realist Evaluation approach, an existing Initial Program Theory (IPT) on working elements in alcohol interventions, was tested by conducting semi-structured interviews with professionals (N = 20). These professionals provide interventions targeting alcohol use across several contexts: with or without practitioner involvement; in-person or not; and in an individual or in a group setting. Data were coded and links between contexts, elements, mechanisms and outcomes were sought for in order to confirm, refute or refine the IPT. Results Several general working elements were found: 1) pointing out the risks and consequences of drinking behavior, 2) paying attention to abstinence, 3) contact with peers, 4) personalized content and 5) providing support. We also found context-specific working elements:1) personalized content and conversations in interventions with practitioners, 2) safety, trust and feeling connected in in-person interventions and 3) sharing experiences and tips in group interventions. Conclusions Findings are in general in line with the IPT. Our findings emphasize the need for social contacts and support for older adults. The mechanisms awareness and accessibility were important contributors to positive interventions outcomes. Further research should study the perspective of older adults and their relatives on interventions. Key messages • Social contacts and support are needed in interventions to reduce and prevent problematic alcohol use in older adults. • Awareness and accessibility are important contributors to positive interventions outcomes in interventions to reduce and prevent problematic alcohol use in older adults.

Emotion Regulation Difficulties Moderate the Association Between Typical Drinking and Sexual Assault Victimization Among Sexual and Gender Minority University Students.

Sexual and gender minority (SGM) students report higher alcohol consumption, emotion regulation difficulties, and sexual assault victimization severity than cisgender, heterosexual individuals. A sample of 754 undergraduate students completed an online survey assessing alcohol use, emotion regulation, and sexual victimization. Regression analyses indicated that, among SGM students with higher emotion regulation difficulties, typical weekly drinking was positively associated with sexual assault victimization severity, but among cisgender, heterosexual students and SGM students with lower emotion regulation difficulties, there was no association between drinking and victimization severity. Thus, SGM students benefit from interventions targeting alcohol use and emotion regulation difficulties.

High Spirits? Exploring "Halloweekend" Alcohol and Cannabis Use Among Heavy-Drinking College Students.

Specific events are associated with heavier and riskier substance use behaviors among college students, including holidays like Halloween, which may include several days of themed parties/events ("Halloweekend"). The current study compared drinking, pregaming (i.e., fast-paced drinking before going out for the night), cannabis use, same-day alcohol and cannabis co-use, and negative alcohol-related consequences over Halloweekend compared with two adjacent non-Halloween weekends among a sample of heavy-drinking university students. Participants (N = 228; 65% female) provided 28 days of daily diary data. We used a three-level generalized linear mixed model (GLMM) approach estimating zero-inflated Conway-Maxwell Poisson regressions to assess the effect of weekend and specific weekend day on number of overall drinks, number of pregaming drinks, and negative alcohol-related consequences. Proportions tests assessed for differences in any cannabis use and daily co-use between Halloweekend and non-Halloween weekends. Zero-inflated portions of the GLMMs indicated that general drinking, pregaming, and negative consequences were most prevalent on Halloweekend and Fridays and Saturdays. Count portions of the models indicated that general drinking quantity was highest during these periods, and participants experienced a greater number of negative consequences on Halloweekend compared with the weekend before; no differences were observed in the quantity of pregaming drinks consumed across weekends or days. No significant differences in cannabis use or co-use were observed between weekends. Given risk associated with Halloweekend compared with weekends immediately before and after, interventions targeting alcohol use and pregaming on Halloweekend may be beneficial to reduce related harm for heavy-drinking students.

Effects of a Patient-Centered Intervention to Reduce Alcohol Use Among Youth With Chronic Medical Conditions

PurposeAlcohol poses unique risks for youth with chronic medical conditions (YCMC) yet many drink. Preventive interventions targeting YCMC are scarce. MethodsYCMC with type 1 diabetes, juvenile idiopathic arthritis, systemic lupus erythematosus, or inflammatory bowel disease were recruited and randomized to trial the effects of a self-administered condition-tailored psychoeducational intervention on frequency in days of past 3-month alcohol use, alcohol-related risk perceptions, and knowledge. Changes in outcomes over time were measured and compared by treatment arm using multivariate mixed effects models. ResultsAmong N = 418 participants (average age 16.0 years, 52.2% female, 84.7% white, 90.7% non-Hispanic), 24.2% reported past-year alcohol use at baseline. Alcohol-related knowledge increased overall and was greater for the intervention group (adjusted improvement in knowledge score +7.70, 95% confidence interval [CI] 2.92–12.48). By 6-month follow-up, the percentage of youth reporting any alcohol use is risky/dangerous increased among intervention arm participants from 41.5% to 45.4% at baseline and decreased from 38.9% to 37.4% among controls (adjusted intervention effect odds ratio 1.79, 95% confidence interval 1.02–3.13). Overall, frequency of drinking increased over time from 3.72 to 4.52 days on average, with no differences by treatment group. Among female drinkers, the predicted mean frequency of drinking days declined in the intervention group (4.11–3.33) and increased among controls (2.82–4.55) (adjusted intervention effect rate ratio .50, 95% confidence interval .25–.99). ConclusionsExposure to a chronic illness–tailored psychoeducational intervention targeting alcohol use increased knowledge and perceived risk and, among females, reduced alcohol use. Promising results merit future work to optimize the model for both males and females.

EHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review.

BackgroundChronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas.ObjectiveThis is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping.MethodsA systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool.ResultsAs of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022.ConclusionsThis systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations.Trial RegistrationPROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119International Registered Report Identifier (IRRID)PRR1-10.2196/35408

Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary.

Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. Protocol Registry: PROSPERO CRD42017055549.

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa

ObjectiveTo investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking.DesignMulticentre, individual, randomised controlled trial where participants were assigned...

461Alcohol use and anti-retroviral adherence among people living with HIV in ART centre of Nepal

Abstract Background Alcohol use is known to have higher prevalence among HIV infected individuals. Hazardous use of alcohol in many studies is negatively associated with the adherence to antiretroviral therapy. Use of alcohol and ART adherence among PLHIV is inadequately explored in Nepalese context. This study aimed at identifying the level of alcohol use and its relationship with adherence to ART among PLHIV. Methods A total of 205 PLHIV of age 18 years or more were randomly selected at a national ART centre of Nepal. Self-reported adherence questionnaire was used to get the level of adherence, Alcohol Use Disorder Identification Test (AUDIT) with five questions was adopted for screening the hazardous alcohol use. Those who took more than 95% of the prescribed doses were considered as adherent. Results About 86% of the respondents were adherent to ART in four days recall. About one third of the respondents were alcohol user and 40% of them had hazardous use of alcohol. Those having hazardous use of alcohol were four times (AOR=4.60, 95% CI 1.27,16.62) more likely to be non-adherent as compared to those who had not hazardous use of alcohol. Multivariate analyses adjusted ethnicity, Knowledge on dangers of non-adherence, subjective feeling of own health, use of memory aid, IDU background, treatment substitution and depression category. Conclusion Hazardous use of alcohol was independently associated with non-adherence with the ART. Key message Screening at the start of the treatment and intervention targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use.

Pre-Intervention Effects of a Community-Based Intervention Targeting Alcohol Use (LEF); The Role of Participatory Research and Publicity.

This study explores the impact of the ‘pre-intervention effects’ of a community-based intervention. This refers to participatory research processes and parallel publicity in the media on changes in alcohol use and relevant mechanisms (rules and norms about alcohol, accessibility of alcohol in a formal setting) among adolescents before any intervention is implemented. The aim was to investigate the contribution of these processes (i.e., pre-intervention effects) to changes in intervention-targeted factors before any actual intervention was implemented. In a quasi-experimental study, data were collected twice by means of self-report among adolescents living in two municipalities (control and experimental condition). A regression analysis showed negative pre-intervention main effects on adolescents’ perceived accessibility of alcohol in a formal setting. Moreover, among adolescents aged 15 years and older, the normative decline in strictness of rules and norms was less steep in the experimental condition compared to the control condition. Additionally, adolescents aged 14 years and younger in the experimental condition reported more weekly drinking compared to their peers in the control condition. No differential effects across gender were found. To conclude, applying a co-creational approach in the development of an intervention not only contributes to more effective interventions in the end, but the involvement of and discussions in the community when planning the intervention contribute to changes in targeted factors. This implies that public discussions about the development of intervention strategies should be considered as an essential feature of co-creation in community-based interventions.

NAFLD and Alcohol-Associated Liver Disease Will Be Responsible for Almost All New Diagnoses of Cirrhosis in Canada by 2040.

Mortality secondary to cirrhosis in North America is increasing. We describe the incidence of cirrhosis stratified by birth cohort and cirrhosis etiology and project disease burden to 2040. This is a retrospective cohort study in Ontario, Canada, using population-based administrative health care data. Individuals with incident cirrhosis (2000-2017) were identified, and etiology was defined as HCV, HBV, NAFLD, alcohol-associated liver disease (ALD), or autoimmune liver disease/other using validated case definitions. Annual age/sex-adjusted cirrhosis incidence rate per 100,000 person-years was calculated with incidence projection to 2040 using age-period-cohort modeling along with average annual percent change (AAPC) in cirrhosis incidence stratified by birth cohort and etiology. In total, 159,549 incident cases of cirrhosis were identified. Incidence increased by 26% with an AAPC of 2%/year (95% CI, 1.6-2.4; P<0.001). The largest increases were for HCV (AAPC, 4.1%/year; 95% CI, 2.6-5.7; P<0.001) and NAFLD (AAPC, 3.3%/year; 95% CI, 2.6-4.1%; P<0.001). ALD and HCV cirrhosis in those born >1980 increased by 11.6%/year (95% CI, 9.3-13.9; P<0.001) and 9.5%/year (95% CI, 6.2-13.0; P<0.001), respectively. However, by 2040, cirrhosis incidence is projected to continue to increase, driven mostly by NAFLD, especially in postmenopausal women, and ALD in individuals born >1980. Cirrhosis incidence will continue to increase over the next two decades secondary to NAFLD with a worrisome rapid rise in ALD cirrhosis among young adults. Public education, policy, and intervention targeting NAFLD risk factors and alcohol use in young adults are urgently needed.

Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis.

This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Integrated CBI showed a small effect size for AOD (g=0.188, P=0.061; I2=86%, τ2=0.126, k=18) and MHD (g=0.169, P=0.024; I2=58%, τ2=0.052, k=18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI+usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes. The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.

Does academic streams influence alcohol use in colleges?

Background:Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India.Aims:To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India.Settings and Design:This is a cross-sectional survey conducted among college students.Materials and Methods:5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains.Statiscal Analysis:Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use.Results:The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing “other” stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses.Conclusion:The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

BackgroundExcessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs.MethodsA prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI).ResultsThis analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7–15) in 14.3%, harmful alcohol use (AUDIT 16–19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63–1.92) or late ART refill (aRR 1.13, 95%CI 0.82–1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42–3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84–3.71).ConclusionsIn this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.

Preliminary Efficacy of a Cognitive Behavioral Therapy Text Messaging Intervention Targeting Alcohol Use and Antiretroviral Therapy Adherence: A Randomized Clinical Trial.

To date, no studies have reported the use of text messaging to deliver cognitive behavioral therapy (CBT) to alcohol users with HIV. We developed and evaluated a text messaging-based program to deliver CBT targeting both alcohol use and adherence to antiretroviral (ART) medications for adults with alcohol use disorders and comorbid HIV. Participants were randomly assigned to receive either a 12-week CBT-based text messaging intervention (ALC-TXT-CBT) targeting ART adherence and alcohol use (n = 18); or an informational pamphlet (INFO) comprising educational content focused on alcohol use and medication adherence (n = 17). ART adherence and alcohol use were compared for those in ALC-TXT-CBT to INFO across baseline and 12-week (i.e., treatment-end) assessments using mixed model regression analyses and paired t-tests. Relative to those in INFO, ALC-TXT-CBT participants evidenced increases in ART adherence, measured by phone-based unannounced pill counts (β = .16, p = .04), and biochemically by viral load (t = -2.0, p = .04) at treatment-end. ALC-TXT-CBT participation was also associated with reductions in heavy drinking at treatment-end (t = 2.7, p = 0.02), while overall alcohol use frequency did not differ significantly between groups (t = 1.5, p = 0.07). Findings demonstrated promising preliminary evidence for the efficacy of ALC-TXT-CBT in improving medication adherence and reducing heavy alcohol use among individuals with alcohol use disorders and comorbid HIV infection.Trial registrationThis trial was registered with ClinicalTrials.gov, NCT02603471.

Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis

ABSTRACT Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n = 5624) that assessed changes in self-efficacy and were included in a random-effects meta-analysis. Interventions targeted: healthy eating (k = 4), physical activity (k = 9), sexual behaviour (k = 3) and smoking (k = 4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy . The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Q-between = 7.3704, p = .061, df = 3). Inclusion of the BCT ‘information about social and environmental consequences’ had a small, negative effect on self-efficacy . Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.

Pilot Study of an Integrated Smartphone and Breathalyzer Contingency Management Intervention for Alcohol Use.

Monitoring devices provide a platform for assessing alcohol use and implementing alcohol interventions. This pilot study focused on assessing the early-stage feasibility and usability of a smartphone-based application and breathalyzer used in a contingency management intervention for alcohol use. Six nontreatment-seeking participants completed a 9-week ABA within-subjects designed intervention targeting alcohol use. Participants submitted 2 to 8 alcohol breathalyzer samples per day and completed self-report drinking measures and usability assessments. During the A phases (weeks 1-3 and 8-9), participants received reinforces for submitting breathalyzer samples, regardless of their results. During the contingency management, B phase (weeks 4-7), and received reinforcers only when negative breathalyzer samples were submitted. Usability assessment of the application was also conducted during weeks 2 and 9. Participants in the contingent B phase (49%) were more likely to submit alcohol-negative breathalyzer samples compared with the noncontingent A phases (27%; P < 0.001). Usability assessment of the application varied, and participants noted several technical concerns. The use of smartphones and breathalyzers may be a practical solution to extend the reach of contingency management during and after treatment.