Among those with HIV, heavy drinking predicts poor antiretroviral therapy (ART) adherence, and substantially increases mortality and morbidity through harmful effects on the liver. Thus, effective and scalable drinking interventions are urgently needed to improve the health and survival of heavy-drinking HIV patients. Brief drinking interventions in non-dependent general primary care patients are effective, but alcohol dependent patients need more extensive intervention. Tested drinking-reduction interventions for HIV populations require considerable personnel time. To extend brief intervention in the HIV clinic with little extra demand on staff time, we harnessed communication technology to develop HealthCall, an innovative enhancement of brief drinking- reduction intervention for urban HIV patients. HealthCall uses technology to engage patients in brief daily self- monitoring of drinking, ART adherence, and other health behaviors over 60 days. The self-monitoring data are then summarized for patients, providing personalized feedback for brief review and discussion at 30 and 60 days. Patient satisfaction with HealthCall is high. Importantly, in urban alcohol dependent HIV primary care patients, we showed that HealthCall is effective at reducing heavy drinking when paired with brief Motivational Interviewing (MI;MI+HealthCall). Since then, formative work also indicated ways to increase HealthCall focus on antiretroviral therapy (ART) adherence. MI is theory-driven, evidence-based, and effective, but requires careful training, supervision and skill for successful outcome. Pairing HealthCall with a more scalable brief intervention would offer wider public health benefits. NIAAA recommends the Clinician's Guide (CG) as a brief, evidence-based approach to alcohol intervention for health care personnel who do not have counseling backgrounds. Compared to MI, CG requires less training and specific skills, thus potentially lowering costs and improving scalability when paired with HealthCall. CG also can readily incorporate attention to ART adherence. We propose a randomized trial to compare MI+HealthCall, CG+HealthCall and CG-only in 300 English- or Spanish-speaking alcohol dependent HIV patients at three diverse urban HIV clinics. The primary outcome is drinking reduction. Important secondary outcomes are ART adherence, viral load, and retention in HIV care, smoking, and the relative cost of each intervention. We will also explore if treatment effects on drinking are moderated by site or patient characteristics, and mediated by theoretically based mechanisms (commitment to change;self-efficacy). Durability of effects will be assessed through 12-month follow-up. Our scientific team has expertise in alcohol, ART adherence, technology-based brief interventions, and cost analysis, and is thus well positioned for a successful study. Responding to PA-13-121, this study will provide information on the efficacy of HealthCall to reduce drinking in HIV alcohol dependent patients when paired with two brief, evidence-based interventions that differ in their potential for scalability, addressing the need for innovative yet evidence-based brief interventions to improve the health and survival of alcohol dependent HIV patients.

Public Health Relevance

In HIV patients, heavy drinking predicts poor antiretroviral therapy (ART) adherence and substantially increased mortality and morbidity through liver disease;thus effective, scalable drinking-reduction interventions are urgently needed for this population. HealthCall, a technology-based enhancement of brief intervention, offers an innovative way to extend patient involvement in drinking-reduction interventions without unreasonably burdening clinical staff. This study, comparing the efficacy and costs of HealthCall paired with two evidence- based brief interventions that differ in their potential for scalability,will advance public health by providing important information on effective and scalable drinking-reduction interventions for alcohol dependent patients in urban HIV care, addressing alcohol, termed the forgotten drug of the HIV epidemic.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Roach, Deidra
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New York State Psychiatric Institute
New York
United States
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Algur, Yasemin; Elliott, Jennifer C; Aharonovich, Efrat et al. (2018) A Cross-Sectional Study of Depressive Symptoms and Risky Alcohol Use Behaviors Among HIV Primary Care Patients in New York City. AIDS Behav 22:1423-1429
Elliott, Jennifer C; Brincks, Ahnalee M; Feaster, Daniel J et al. (2018) Psychosocial Factors Associated with Problem Drinking Among Substance Users with Poorly Controlled HIV Infection. Alcohol Alcohol 53:603-610
Elliott, Jennifer C; Stohl, Malka; Hasin, Deborah S (2018) Heavy drinking among individuals with HIV: who drinks despite knowledge of the risk? AIDS Care 30:560-563
Elliott, Jennifer C; Shalev, Noga; Hasin, Deborah S (2018) Heavy Drinking and Treatment among HIV/HCV Co-Infected Patients. J Subst Abus Alcohol 6:
Elliott, Jennifer C; Stohl, Malka; Hasin, Deborah S (2017) Drinking despite health problems among individuals with liver disease across the United States. Drug Alcohol Depend 176:28-32
Elliott, Jennifer C; Hasin, Deborah S; Des Jarlais, Don C (2017) Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs. Addict Behav 72:21-26
Sarvet, Aaron L; Hasin, Deborah (2016) The natural history of substance use disorders. Curr Opin Psychiatry 29:250-7
Elliott, Jennifer C; Hasin, Deborah S; Stohl, Malka et al. (2016) HIV, Hepatitis C, and Abstinence from Alcohol Among Injection and Non-injection Drug Users. AIDS Behav 20:548-54
Elliott, Jennifer C; Stohl, Malka; Aharonovich, Efrat et al. (2016) Reasons for drinking as predictors of alcohol involvement one year later among HIV-infected individuals with and without hepatitis C. Ann Med 48:634-640
Elliott, Jennifer C; Hasin, Deborah S; Des Jarlais, Don C (2016) Perceived risk for severe outcomes and drinking status among drug users with HIV and Hepatitis C Virus (HCV). Addict Behav 63:57-62

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