Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial

• Type of Material: Article
• Authors: E. Jennifer Edelman, Yale University; Stephen A. Maisto, Syracuse University; Nathan B. Hansen, Yale University; Christopher J. Cutter, Yale University; James Dziura, Yale University; Yanhong Deng, Yale University; Lynn E. Fiellin, Yale University; Patrick G. O'Connor, Yale University; Roger Bedimo, University of Texas Southwestern; Cynthia L. Gibert, Washington University in St. Louis; Vincent Marconi, Emory University; David Rimland, Emory University; Maria C. Rodriguez-Barradas, Michael E DeBakey VAMC; Michael S. Simberkoff, VA New York Harbor Healthcare System; Janet P. Tate, Yale University; Amy C. Justice, Yale University; Kendall J. Bryant, National Institute On Alcohol Abuse and Alcoholism; David A. Fiellin, Yale University
• Language: English
• Date: 2020-07-29
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13722-020-00200-y
• Title of Journal or Parent Work: ADDICTION SCIENCE & CLINICAL PRACTICE
• Volume: 15
• Issue: 1
• Start Page: 28
• End Page: 28
• Grant/Funding Information: This work was generously support by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (grant #U01AA020795, U01AA020790, U24AA020794). EJ Edelman was supported as a Yale-Drug Abuse, HIV and Addiction Research Scholar (NIDA grant #K12DA033312) during the conduct of this work. NIAAA staff (KJB) collaborated in the design of the study and provided comments for consideration in drafts of the manuscript.
• Keywords: INFECTION; NALTREXONE; BRIEF INTERVENTION; KNOWLEDGE; PRIMARY-CARE; Life Sciences & Biomedicine; Science & Technology; DRINKERS; Integrated; Delivery of health care; HEAVY DRINKING; Substance Abuse; Alcohol-related disorders; PHARMACOTHERAPY; CONSUMPTION; MORTALITY; HIV
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

Background: At-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. Methods: In 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. Results: Despite 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)]. Conclusion: An 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