The objective of the current research is to improve treatment for alcohol dependent adults by augmenting naltrexone pharmacotherapy with an innovative text-messaging strategy to promote relapse prevention skills, reduce HIV-risk behaviors, and improve naltrexone and HIV treatment regimen adherence. This application is in response to PA-10-013, "Behavioral &Integrative Treatment Development Program," which encourages "Studies on evidence-based treatment interventions that utilize various technologies in order to increase efficacy and/or increase community-friendliness;Research on behavioral treatments that complement and/or potentiate the effects of medications;Research on treatment interventions for...medical conditions that are co- occurring with substance abuse;and research on the development of methods and technologies relevant to treatment, adherence, and HIV prevention within the context of drug abuse treatment." Consistent with these stated objectives of the PA, the specific aims of this research are 1) To develop and refine, with user feedback, a cognitive behavioral therapy-based text-messaging intervention (TXT-CBT) to augment pharmacotherapy for alcohol dependence in HIV-infected adults with alcohol use disorders;2) To conduct a pilot randomized clinical trial to assess the feasibility of recruiting and retaining individuals for a large scale study and to determine the effect size of TXT-CBT over and above medication management with naltrexone (MM) on alcohol use, HIV medication adherence, naltrexone adherence, and healthcare outcomes. Both MM and MM+TXT-CBT participants will be assessed at baseline, treatment-end, and 12 weeks post-treatment;and 3) To examine potential mechanisms of action of TXT-CBT, including self-efficacy, coping skills, and social support. We hypothesize that TXT-CBT delivered in conjunction with MM will produce greater reductions in alcohol use and HIV-risk behaviors, and will improve naltrexone and HIV treatment regimen adherence, relative to MM alone. Further, we expect that MM+TXT-CBT will facilitate greater changes in, self-efficacy, coping skills, and social support, and these changes will be associated with substance use outcomes. Preliminary data concerning cost-effectiveness will be gathered to begin to evaluate the cost savings associated with this technology-based intervention. TXT-CBT incorporates specific substance- and adherence-focused cognitive therapy techniques with a concurrent emphasis on reducing HIV-risk behaviors. By providing support to maximize HIV treatment regimen adherence, coupled with coping skills to prevent alcohol relapse, TXT-CBT may provide a promising, cost-effective, and easily deployable augmenting strategy for the treatment of alcohol users who are HIV- infected.
The proposed research is of considerable public health significance in that it will provide foundational information on the use of mobile phone technology as a delivery medium for behavioral support for HIV-infected adults with alcohol dependence, co-occurring conditions which pose serious problems with extensive impacts. If proven effective, the protocol could be useful in reducing alcohol use and improving HIV treatment regimen adherence among treated individuals, thereby efficiently reducing alcohol abuse and related consequences such as social disruption, elevated risk of HIV transmission/infection, and poorer health outcomes from HIV. This investigation will establish the clinical utility of an innovative tailored and interactive text-messaging intervention with potential for rapid and broad deployment to alcohol- dependent individuals who are at the greatest risk for HIV infection and transmission.