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

E. Jennifer Edelman, Stephen A. Maisto, Nathan B. Hansen, Christopher J. Cutter, James Dziura, Yanhong Deng, Lynn E. Fiellin, Patrick G. O'connor, Roger Bedimo, Cynthia L. Gibert, Vincent C. Marconi, David Rimland, Maria C. Rodriguez-Barradas, Michael S. Simberkoff, Janet P. Tate, Amy C. Justice, Kendall J. Bryant, David A. Fiellin

Research output: Contribution to journalArticle

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

Original languageEnglish (US)
Article number28
JournalAddiction Science and Clinical Practice
Volume15
Issue number1
DOIs
StatePublished - Jul 29 2020

Keywords

  • Alcohol-related disorders
  • Delivery of health care
  • HIV
  • Integrated

ASJC Scopus subject areas

  • Medicine(all)

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    Edelman, E. J., Maisto, S. A., Hansen, N. B., Cutter, C. J., Dziura, J., Deng, Y., Fiellin, L. E., O'connor, P. G., Bedimo, R., Gibert, C. L., Marconi, V. C., Rimland, D., Rodriguez-Barradas, M. C., Simberkoff, M. S., Tate, J. P., Justice, A. C., Bryant, K. J., & Fiellin, D. A. (2020). Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial. Addiction Science and Clinical Practice, 15(1), [28]. https://doi.org/10.1186/s13722-020-00200-y