Telehealth interventions to reduce alcohol use in men with HIV who have sex with men: Protocol for a factorial randomized controlled trial

Kahler, Christopher W.; Surace, Anthony; Durst, Ayla; Pantalone, David W.; Mastroleo, Nadine R.; Míguez, María José; Bueno, Diego; Liu, Tao; Monti, Peter M.; Mayer, Kenneth H.

doi:10.1016/j.conctc.2019.100475

Cited by 9 publications

(4 citation statements)

References 99 publications

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“…Prior to the COVID-19 pandemic, telehealth was recognized as a promising avenue to increase reach of alcohol counseling (Kahler et al, 2019; Lin et al, 2019), as well as LGBTQ-affirming behavioral health care, to those who might not otherwise have access (Whaibeh et al, 2020). However, telehealth had been limited by payer reimbursement schedules (Budak et al, 2021), particularly in Federally-Qualified Health Centers (FQHCs) where reimbursement is a fixed, predetermined amount for all qualifying visits under Medicaid and Medicare (Uscher-Pines et al, 2022).…”

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confidence: 99%

“…To address these knowledge gaps, it is important to consult with TGD individuals to learn (a) needed adaptations to the content discussed in MI for alcohol use and (b) provider skills that demonstrate an effective multicultural orientation when delivering MI for alcohol use. MI delivered via telehealth may also provide an opportunity for increased reach (Kahler et al, 2019) and has been a necessity at several times throughout the COVID-19 pandemic (Doraiswamy et al, 2020). It is important to understand how adaptations in content and delivery of MI for alcohol use with TGD clients would be implemented in a telehealth format.…”

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confidence: 99%

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Transgender and gender diverse adults’ reflections on alcohol counseling and recommendations for providers.

Guy¹,

Surace²,

Zelaya³

et al. 2023

American Journal of Orthopsychiatry

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Transgender and gender diverse (TGD) populations experience health disparities due to societal stigma that increases TGD individuals’ sources of stress and decreases access to health protective resources. Research has linked experiences of stigma to risky alcohol use, yet there remains a dearth of culturally sensitive alcohol use interventions that meet the needs of TGD people. The present study was conducted to inform modifications to the content and delivery of an existing brief, telehealth, motivational intervention to decrease at-risk alcohol use among TGD adults. Individual semi-structured in-depth qualitative interviews were conducted with TGD adults who reported recent alcohol use (n = 18) to explore factors that facilitate positive interactions with health care providers and identify relevant information for alcohol use disorder treatment. Participants were recruited from an LGBTQ+-focused health center in Los Angeles, California. Two major themes and recommendations emerged: (a) A multicultural orientation of humility is important to develop productive therapeutic relationships with TGD clients when delivering motivational interviewing; (b) Due to insufficient appropriate data on alcohol use and health in TGD populations, feedback used in motivational alcohol counseling needs to be modified to better serve TGD clients. These findings show that counselors’ philosophy and behavior, as well as session content, need to be considered when working with TGD populations within the context of alcohol counseling. These findings also have implications for intervention development, clinical treatment, and future research.

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confidence: 99%

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confidence: 99%

Transgender and gender diverse adults’ reflections on alcohol counseling and recommendations for providers.

Guy¹,

Surace²,

Zelaya³

et al. 2023

American Journal of Orthopsychiatry

Self Cite

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“…This allowed us to investigate whether the relative performance of the decision-making approaches changes with smaller versus larger sample size. Half of our simulated optimization trials had larger total sample sizes ( n = 640; e.g., Piper et al, 2016), and half had smaller sample sizes ( n = 128, or smaller than those commonly used in practice, e.g., Kahler et al, 2019). We chose these sample sizes with the goal of reflecting current practice.…”

Section: Methodsmentioning

confidence: 99%

A posterior expected value approach to decision-making in the multiphase optimization strategy for intervention science.

Strayhorn¹,

Vanness²

2023

Psychological Methods

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In current practice, intervention scientists applying the multiphase optimization strategy (MOST) with a 2k factorial optimization trial use a component screening approach (CSA) to select intervention components for inclusion in an optimized intervention. In this approach, scientists review all estimated main effects and interactions to identify the important ones based on a fixed threshold, and then base decisions about component selection on these important effects. We propose an alternative posterior expected value approach based on Bayesian decision theory. This new approach aims to be easier to apply and more readily extensible to a variety of intervention optimization problems. We used Monte Carlo simulation to evaluate the performance of a posterior expected value approach and CSA (automated for simulation purposes) relative to two benchmarks: random component selection, and the classical treatment package approach. We found that both the posterior expected value approach and CSA yielded substantial performance gains relative to the benchmarks. We also found that the posterior expected value approach outperformed CSA modestly but consistently in terms of overall accuracy, sensitivity, and specificity, across a wide range of realistic variations in simulated factorial optimization trials. We discuss implications for intervention optimization and promising future directions in the use of posterior expected value to make decisions in MOST.

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“…Despite the importance of decreasing heavy drinking in PLWH, a growing literature of trials assessing alcohol interventions among PLWH shows that many interventions either lack efficacy or are very time-consuming 18,19 . Some HIV alcohol primary care interventions have been designed for easier dissemination, e.g., those based on the Screening and Brief Intervention with Referral to Treatment (SBIRT) model 20-22 and interventions utilizing technology 23,24 . Interventions facilitated by technology are especially timely in the era of COVID-19, where telehealth has been used in HIV clinics to limit risk of COVID-19 infection 25 .…”

Section: Introductionmentioning

confidence: 99%

HealthCall: Smartphone Enhancement of Brief Interventions to Reduce Heavy Drinking In HIV Care

Hasin

Aharonovich

Zingman

et al. 2020

Preprint

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BackgroundHeavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their continuum of care. Brief interventions to reduce heavy drinking in primary care are effective, but in heavy-drinking PLWH, more extensive intervention may be needed. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed the “HealthCall” app to provide continued engagement after brief intervention, in order to reduce drinking and improve other aspects of HIV care while making minimal demands on providers.MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinician’s Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline drinking-reduction interventions were ∼25 minutes, with brief (10-15 min) check-in sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking and other aspects of the prior 24 hours. Outcomes assessed at 30 and 60 days, and 3, 6 and 12 months, included drinks per drinking day, drinks per day, and days drank, using the Timeline Followback. Analysis were conducted using generalized linear mixed models with pre-planned contrasts.ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. During treatment, patients in MI+HealthCall drank less than others (p=0.07-0.003). However, at 6 and 12 months, drinking was lowest among patients who had been in CG+HealthCall (p=0.04-0.06).ConclusionDuring treatment, patients in MI+HealthCall drank less than patients in the CG conditions. However, at 6 and 12 months, drinking was lower among patients in CG+HealthCall. Given the importance of drinking reduction and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

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Telehealth interventions to reduce alcohol use in men with HIV who have sex with men: Protocol for a factorial randomized controlled trial

Cited by 9 publications

References 99 publications

Transgender and gender diverse adults’ reflections on alcohol counseling and recommendations for providers.

Transgender and gender diverse adults’ reflections on alcohol counseling and recommendations for providers.

A posterior expected value approach to decision-making in the multiphase optimization strategy for intervention science.

HealthCall: Smartphone Enhancement of Brief Interventions to Reduce Heavy Drinking In HIV Care

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