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

  • Derek D. SatreEmail author
  • 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



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.


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.


Randomized clinical trial.


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


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.


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 (


HIV alcohol primary care motivational interviewing digital health adaptive intervention SBIRT 



We thank Stephen Follansbee, Alison Truman and Georgina Berrios for assistance in completing the study, and Agatha Hinman for assistance in preparing the manuscript.


This study was funded by the National Institute on Alcohol Abuse and Alcoholism (U01 AA021997 and K24 AA025703).

Compliance with Ethical Standards

Conflict of Interest

All authors declare no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Derek D. Satre
    • 1
    • 2
    Email author
  • Amy S. Leibowitz
    • 2
  • Wendy Leyden
    • 2
  • Sheryl L. Catz
    • 3
  • C. Bradley Hare
    • 4
  • Hannah Jang
    • 2
  • Jennifer O. Lam
    • 2
  • Kendall J. Bryant
    • 5
  • Constance M. Weisner
    • 1
    • 2
  • Stacy A. Sterling
    • 2
  • Michael Horberg
    • 6
  • Paul Volberding
    • 7
  • Michael J. Silverberg
    • 2
  1. 1.Department of Psychiatry, Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoUSA
  2. 2.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  3. 3.Betty Irene Moore School of NursingUniversity of CaliforniaSacramentoUSA
  4. 4.Kaiser Permanente San Francisco Medical CenterSan FranciscoUSA
  5. 5.National Institute on Alcohol Abuse and AlcoholismBethesdaUSA
  6. 6.Mid-Atlantic Permanente Research InstituteKaiser Permanente Mid-Atlantic StatesRockvilleUSA
  7. 7.AIDS Research InstituteUniversity of CaliforniaSan FranciscoUSA

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