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Decreased Alcohol Consumption in an Implementation Study of Computerized Brief Intervention among HIV Patients in Clinical Care

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Abstract

This prospective, nonrandomized implementation study evaluated a computerized brief intervention (CBI) for persons with HIV (PWH) and heavy/hazardous alcohol use. CBI was integrated into two HIV primary care clinics. Eligible patients were engaged in care, ≥ 18 years old, English speaking, endorsed heavy/hazardous alcohol use on the Alcohol Use Disorders Identification Test-C (AUDIT-C). Two 20-min computerized sessions using cognitive behavioral techniques were delivered by a 3-D avatar on touch screen tablets. Of 816 eligible AUDIT-C scores, 537 (66%) resulted in CBI invitation, 226 (42%) of invited patients enrolled, and 176 (78%) of enrolled patients watched at least one session. CBI enrollment was associated with a significant average reduction of 9.1 drinks/week (95% CI − 14.5, − 3.6) 4–12 months post-enrollment. Among those who participated in one or both sessions, average reduction in drinks/week was 11.7 drinks/week (95% CI − 18.8, − 4.6). There was corresponding improvement in AUDIT-C scores. Overall patients reported high levels of intervention satisfaction, particularly among older and Black patients. These promising results point to a practical intervention for alcohol reduction in this vulnerable patient population with elevated rates of heavy/hazardous drinking. Future research should examine strategies to increase initial engagement, strengthen intervention effects to increase the number of patients who achieve non-hazardous drinking, and examine the duration of therapeutic effects.

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Acknowledgements

We are grateful to all patients, physicians, investigators, and staff involved in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We particularly thank the patients, staff, and providers of the University of Washington (UW) Harborview Medical Center Madison HIV Clinic and the University of Alabama at Birmingham 1917 HIV Clinic. We thank Xiaoqiang Xu, MS for assistance with the analyses, David Sheehan, MD, MBA for permission to use the MINI AUD module for our research, Steven Ondersma, Ph.D. for his guidance in programming Peedy, and Kendall Bryant, PhD for serving as Scientific Advisor to the project.

Funding

National Institute on Alcohol Abuse and Alcoholism Grant Number AA020801, AA020802, AA020793. National Institute of Allergy and Infectious Diseases Grant Number AI067039, AI027757.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115, Baltimore, MD, 21205, USA

    Mary E. McCaul & Heidi E. Hutton

  2. Department of Psychiatry and Behavioral Neurobiology, University of Alabama At Birmingham, Birmingham, AL, USA

    Karen L. Cropsey

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Heidi M. Crane & Mari M. Kitahata

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Catherine R. Lesko & Bryan Lau

  5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Geetanjali Chander

  6. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Michael J. Mugavero & Michael S. Saag

Authors
  1. Mary E. McCaul
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  2. Heidi E. Hutton
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  7. Michael J. Mugavero
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  8. Mari M. Kitahata
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  9. Bryan Lau
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Contributions

All authors contributed to the study conception and design. Intervention development was completed by HEH and MEMc. Data collection was overseen by KC and MJM at the University of Alabama, Birmingham, and HMC at the University of Washington. Analyses were performed by CRL and BL. The first draft of the manuscript was written by MEMc and CRL. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mary E. McCaul.

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Conflict of interest

HC has received grant funding from ViiV. Other authors have no relevant financial or non-financial interests to disclose. The other authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical Approval

This research was approved by the Institutional Review Board at the participating sites – The University of Alabama at Birmingham and the University of Washington, Seattle. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all PWH included in the study.

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McCaul, M.E., Hutton, H.E., Cropsey, K.L. et al. Decreased Alcohol Consumption in an Implementation Study of Computerized Brief Intervention among HIV Patients in Clinical Care. AIDS Behav 25, 4074–4084 (2021). https://doi.org/10.1007/s10461-021-03295-9

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