Reducing heavy drinking in <scp>HIV</scp> primary care: a randomized trial of brief intervention, with and without technological enhancement

Hasin, Deborah S.; Aharonovich, Efrat; O’Leary, Ann; Greenstein, Eliana; Pavlicová, Martina; Arunajadai, Srikesh; Waxman, Rachel; Wainberg, Milton L.; Helzer, John E.; Johnston, Barbara

doi:10.1111/add.12127

Cited by 110 publications

(230 citation statements)

References 39 publications

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“…A study among HIV patients found that the mean number of drinks per drinking days was 3.58 (Standard Deviation (SD): 1.81) under an enhanced MI vs. 4.75 (SD: 3.22) under the control arm [43]. For two-sided testing at a significance level of 5% and power of 90%, with one pre- and three post- intervention measures with a within subject correlation of 0.7 between measurements, the required sample size using analysis of covariance methods is 260.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

et al. 2014

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BackgroundLittle research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention.Methods/DesignA randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions.DiscussionWe have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes.Trial registrationPan African Clinical Trials Register Number: PACTR201405000815100.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-500) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

et al. 2014

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“…When supplementary human support was used (for 7 trials that enrolled adults and 3 that enrolled students), it was typically limited, consisting only of technical support from a research assistant in more than one half of the cases (for 4 trials that enrolled adults and 3 that enrolled students). However, therapeutic support varied substantially, with some e-interventions supplemented by 1.5 to 6.5 hours of support (33)(34)(35)(36).…”

Section: E-intervention Characteristics and Supportmentioning

confidence: 99%

“…All trials that used relatively intensive human support (n = 3) were conducted in adults (33)(34)(35), and 2 (34,35) In college students, mean alcohol consumption at baseline ranged from 85 to 439 grams per week (median, 183 grams per week). In 11 trials rated as low to moderate risk of bias that used 14 comparisons (37-39, 48-55), e-interventions were associated with a small, statistically significant reduction in alcohol consumption at 6-month follow-up (MD, −11.…”

Section: E-intervention Characteristics and Supportmentioning

confidence: 99%

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

et al. 2015

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“…Participants recognize the impacts of repeated self-assessments and suggest that more frequent assessments might result in greater effects [80]. Self-monitoring by mobile or web-apps also suggest motivational interviewing to reduce substance use and sexual risk are effective with substance users, persons living with HIV and at high-risk for HIV infection [82][83][84][85][86][87]. Recent pilot studies by our team found that coaches using web-based dashboards to monitor clients' progress and facilitate coaching were highly acceptable, enhanced bonds and accountability, and enhanced efficacy of a small group intervention to reduce methamphetamine use and sexual risk behaviors among gay and bisexual men [75,88].…”

Section: Automated Messaging and Monitoring Intervention (Ammi)mentioning

confidence: 99%

Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial (Preprint)

Swendeman¹,

Arnold²,

Harris³

et al. 2018

Preprint

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Background: The rate of HIV has doubled in the last 15 years among young people to 22% of HIV cases. Scientific advances in biomedical HIV prevention strategies have not been utilized by youth. Methods/Design: Young people aged 12 -24 years old (n= 1500) are being recruited from community-based organizations (CBO) and clinics serving gay, bisexual, and transgender youth, homeless youth, youth on probation or released from incarceration, and youth in other high-risk venues (e.g., bars and clubs). Youth are randomized in a factorial design to: 1) an automated messaging and monitoring intervention (AMMI) using text messages (n = 900); 2) AMMI plus peer support via private social media (n = 200); 3) AMMI plus strengths-based coaching (n = 200); and 4) AMMI, peer support, and coaching (n = 200). At four-month intervals over 24 months, interviewers monitor: uptake of the steps in the HIV Prevention Continuum (linkage to health care and adherence to pre-or post-exposure prophylaxis or 100% condom use), and conduct repeat rapid diagnostic tests for HIV, sexually transmitted infections (STI), drugs and alcohol use. Weekly automated monitoring via text (or email) in AMMI includes questions on acute HIV and STI symptoms for immediate follow-up by interviewers to provide HIV and STI testing, STI treatment, and partner therapy. Discussion: The greatest impacts are expected among youth receiving the most intensive intervention (i.e., AMMI, peer support, and coach). However, the youth's concurrent mental health, substance abuse, and housing and food security are expected to be significant covariates that influence the uptake of the HIV Prevention Continuum. This study operationalizes the guidelines of the Centers of Disease Control and Prevention (CDC) regarding the prevention of HIV among the highest risk youth, using community-based point of care diagnostics supported by scalable technology-mediated interventions. Similarly, over 90% of adolescents under age 18 go online daily, more than half several times a day which is facilitated by access to smartphones among 75% of youth of each ethnicity, crossing the digital divide [28]. Much of this online activity is driven by social media use, particularly via smartphones -for example, over 70% of adolescents under 18 years use Facebook, while about half also use Instagram and Snapchat [28]. The interventions in this study use text messaging and social media to engage "youth where they are" in the digital environment. This approach has resulted in four intervention arms which vary in intensity and costs. In order of increasing intensity and costs, the interventions are: 1) automated text-messaging and weekly monitoring probes; 2) peer support via social media; 3) paraprofessional coaching; and 4) all three combined. This study's automated and interpersonally-mediated technology-based interventions will be based on the shared features of existing EBI -we will not create a new app nor an EBI with a manual to be replicated with 6 fidelity [14,33,34]. In the last 25 years, over...

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Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement

Cited by 110 publications

References 39 publications

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial (Preprint)

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