Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial

Derek D Satre; Amy S Leibowitz; Wendy Leyden; Sheryl L Catz; C Bradley Hare; Hannah Jang; Jennifer O Lam; Kendall J Bryant; Constance M Weisner; Stacy A Sterling; Michael Horberg; Paul Volberding; Michael J Silverberg

doi:10.1007/s11606-019-05065-9

Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial

J Gen Intern Med. 2019 Oct;34(10):2054-2061. doi: 10.1007/s11606-019-05065-9. Epub 2019 Jun 11.

Authors

Affiliations

¹ Department of Psychiatry, Weill Institute for Neurosciences, University of California, Box 0984, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA. derek.satre@ucsf.edu.
² Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. derek.satre@ucsf.edu.
³ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
⁴ Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th Street, Suite 2600, Sacramento, CA, 95817, USA.
⁵ Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA, 94115, USA.
⁶ National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
⁷ Department of Psychiatry, Weill Institute for Neurosciences, University of California, Box 0984, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
⁸ Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD, 20852, USA.
⁹ AIDS Research Institute, University of California, San Francisco, CA, 94158, USA.

Abstract

Background: Unhealthy alcohol use has adverse effects on HIV treatment. Screening, brief intervention, and referral to treatment (SBIRT) has some evidence of efficacy but may not be sufficient for those with low motivation or comorbid substance use.

Objective: To examine the effectiveness of motivational interviewing (MI) and emailed feedback (EF) among primary care HIV-positive patients, compared with treatment as usual care (UC) only, which included SBIRT.

Design: Randomized clinical trial.

Participants: Six hundred fourteen adult HIV-positive patients in Kaiser Permanente Northern California who reported prior-year unhealthy alcohol use.

Intervention: Participants were randomized to either three sessions of MI (one in person and two by phone), information regarding alcohol risks via EF through a patient portal, or UC alone. MI and EF participants who reported unhealthy alcohol use at 6 months were offered additional MI and EF treatment, respectively.

Main measures: Participant-reported unhealthy alcohol use (defined as ≥ 4/≥ 5 drinks per day for women/men), alcohol problems at 12 months, based on blinded telephone interviews. Secondary outcomes included drug use and antiretroviral (ART) adherence.

Key results: At 12 months, there were no overall group differences, but in all three arms, there were declines in unhealthy alcohol use and alcohol-related problems (p < 0.001). Participants reporting low motivation to reduce drinking at baseline were less likely to report unhealthy alcohol use if they received MI vs. EF and UC (p = 0.013). At 6 months, reported illegal drug use/misuse of prescription drugs other than marijuana was lower in the MI arm than EF or UC (p = 0.012). There were no differences in ART adherence between groups.

Conclusions: In a randomized trial of HIV-positive patients using two behavioral interventions compared with SBIRT alone, participants in all three conditions reduced unhealthy alcohol use. MI may provide added benefit for patients with low motivation or who report illegal drug use/misuse of prescription drugs.

Trial registration: NCT01671501 ( ClinicalTrials.gov ).

Keywords: HIV; SBIRT; adaptive intervention; alcohol; digital health; motivational interviewing; primary care.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adult
Alcohol Drinking / prevention & control
Alcohol Drinking / psychology
Alcoholism / complications
Alcoholism / psychology
Alcoholism / therapy*
Female
HIV Infections / complications*
HIV Infections / psychology
Humans
Male
Middle Aged
Motivational Interviewing / methods*
Primary Health Care / methods
Text Messaging*

Associated data

ClinicalTrials.gov/NCT01671501

Abstract

Publication types

MeSH terms

Associated data

Grants and funding