Heavy alcohol use in HIV-infected patients may lead to lower adherence to antiretrovirai therapy, greater sexual risk taking, higher viral loads, worse liver functioning, jand worse cognitive functioning. Therefore, interventions to reduce drinking may have particularly positive and widespread effects in HIV-infected patients. Men who have sex with men (MSM) continue to represent almost half of all HIV/AIDS cases in the US, and rates of excessive drinking are particularly high among HIV-infected MSM. Although brief interventions have been shown to reduce alcohol consumption in general primary care settings, the efficacy of brief alcohol interventions in HIV primary care settings has not been established, and no brief alcohol interventions have been tested specifically in a population of HIV-infected MSM. Furthermore, there currently are no data published on the extent to which changes in alcohol use after a brief intervention relate to key HIV-related outcomes (viral, immunologic, hepatic, neurocognitive, and behavioral). The overall aim of this project is to test the efficacy of a brief alcohol intervention for HIV-infected MSM in a primary care setting. This randomized clinical trial uses a 2 group between-subjects design with repeated measures to compare treatment as usual (TAU) to TAU plus a brief intervention to reduce alcohol use (TAUBI). Participants will be 224 heavy drinking HIV-infected MSM receiving care at the Fenway Community Health clinic in Boston. Those assigned to TAU-BI will receive one 60-minute session of in-person counseling and two booster sessions by telephone. Sessions will provide feedback and advice on alcohol use in the context of HIV treatment and will use Motivational Interviewing to develop discrepancies between current drinking behavior and long-term health. Participants will be interviewed at 3, 6, and 12 months. Primary analyses will test the hypotheses (a) that TAU-BI will result in reduced drinking relative to TAU and (b) that greater reductions in alcohol use will be associated with greater adherence to HIV medications, less high-risk sexual behavior, and better viral, hepatic, and neurocognitive outcomes. Secondary and tertiary aims will examine mediation and moderation of TAU-BI effects on these HIV-related outcomes.
This project will help establish an efficacious approach for addressing heavy drinking in HIV-infected MSM in primary care settings. It also will provide valuable insights on the effects of reductions in alcohol use on unsafe sex, medication adherence, and viral, liver, and brain outcomes in HIV-infected patients.
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