Author/Authors :
Edelman, E. Jennifer Yale School of Medicine, New Haven, USA , Maisto, Stephen A. Syracuse University, Syracuse, USA , Hansen, Nathan B. Center for Interdisciplinary Research on AIDS - Yale School of Public Health, New Haven, USA , Cutter, Christopher J. Yale School of Medicine, New Haven, USA , Dziura, James Yale Center for Analytic Sciences - Yale University School of Public Health, New Haven, USA , Deng, Yanhong Yale Center for Analytic Sciences - Yale University School of Public Health, New Haven, USA , Fiellin, Lynn E. Yale School of Medicine, New Haven, USA , O’Connor, Patrick G. Yale School of Medicine, New Haven, USA , Bedimo, Roger D.C. VAMC and George - Washington University School of Medicine and Health Sciences, Washington, USA , Gibert, Cynthia L. D.C. VAMC and George - Washington University School of Medicine and Health Sciences, Washington, USA , Marconi, Vincent C. Atlanta VAMC and Emory University School of Medicine, Atlanta, USA , Rimland, David Atlanta VAMC and Emory University School of Medicine, Atlanta, USA , Rodriguez-Barradas, Maria C. Michael E. DeBakey VAMC and Baylor College of Medicine - Texas Houston, Houston, USA , Simberkoff, Michael S. VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY USA , Tate, Janet P. Yale School of Medicine, New Haven, USA , Justice, Amy C. Yale School of Medicine, New Haven, USA , Bryant, Kendall J. Yale School of Medicine, New Haven, USA , Fiellin, David A. Yale School of Medicine, New Haven, USA
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
