Unhealthy alcohol use threatens the health benefits seen with antiretroviral therapy (ART) for HIV-infected (HIV+) patients. Although research has demonstrated the efficacy of brief interventions, motivational counseling, and medications to treat unhealthy alcohol use in HIV unifected patients, there is limited research or use of these treatments in HIV+ patients. We have demonstrated that integrated treatment of addiction in HIV clinics is feasible. Stepped care algorithms can facilitate the evaluation of varying intensities of treatments for unhealthy alcohol use:~The proposed study will compare onsite Integrated Stepped Care treatment (ISC) to treatment as usual (TAU) in three, linked, 6-month randomized clinical trails in 642 HIV+ patients with unhealthy alcohol use. Screened patients are randomized to ISC or TAU after determining that they meet criteria for either 1) at-risk drinking, 2) alcohol abuse or dependence or 3) moderate alcohol consumption in the presence of liver disease. ISC and TAU are tailored to the drinking category. ISC for at- risk drinkers and those with moderate alcohol use and liver disease begins with a brief intervention and is stepped up to Motivational Enhancement Therapy (MET) in those who meet predefined failure criteria. ISC for abuse or dependence begins with addiction psychiatrist management (ARM) including alcohol pharmacotherapy if not contraindicated. ARM is stepped up to include MET if predefined failure criteria are met. The study will test the hypothesis that ISC leads to decreased alcohol consumption and improved HIV biomarkers. Data analyses will be conducted on the intention to treat sample. The primary outcome is change in alcohol consumption assessed by self report. Secondary outcomes include change in the VACS Index, ART adherence, and sexual risk behaviors. Novel aspects of this proposal include: 1) Integrated alcohol and HIV treatment;2) Stepped care;3) The use of the VACS Index as an expanded HIV biomarker and 4) Participation in COMpAAAS. The proposed study, conducted by an experienced team of HIV and addiction researchers, will help define the role of ISC HIV+ with unhealthy alcohol use.
The goals of this study are to optimize the treatment of HIV disease by decreasing alcohol consumption, improving medication adherence, improving HIV immune markers, and promoting the prevention of HIV spread by decreasing sexual risk in patients with unhealthy alcohol use. The current project will serve to advance this area of research and expand the types of care that HIV-infected patients receive.
|McGinnis, Kathleen A; Tate, Janet P; Williams, Emily C et al. (2016) Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend 168:196-202|
|McGinnis, Kathleen A; Fiellin, David A; Tate, Janet P et al. (2016) Number of Drinks to "Feel a Buzz" by HIV Status and Viral Load in Men. AIDS Behav 20:504-11|
|Rentsch, Christopher; Tate, Janet P; AkgÃ¼n, Kathleen M et al. (2016) Erratum to: Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011. AIDS Behav 20:565|
|Rentsch, Christopher; Tate, Janet P; AkgÃ¼n, Kathleen M et al. (2016) Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011. AIDS Behav 20:555-64|
|Becker, William C; Fiellin, David A; Black, Anne C et al. (2016) Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy. J Rehabil Res Dev 53:127-36|
|Herrin, Melissa; Tate, Janet P; AkgÃ¼n, Kathleen M et al. (2016) Weight Gain and Incident Diabetes Among HIV-Infected Veterans Initiating Antiretroviral Therapy Compared With Uninfected Individuals. J Acquir Immune Defic Syndr 73:228-36|
|Salinas, Jorge L; Rentsch, Christopher; Marconi, Vincent C et al. (2016) Baseline, Time-Updated, and Cumulative HIV Care Metrics for Predicting Acute Myocardial Infarction and All-Cause Mortality. Clin Infect Dis 63:1423-1430|
|Edelman, E Jennifer; Hansen, Nathan B; Cutter, Christopher J et al. (2016) Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics. Addict Sci Clin Pract 11:1|
|Banerjee, Geetanjoli; Edelman, E Jennifer; Barry, Declan T et al. (2016) Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study. Addiction 111:2021-2031|
|Viswanathan, Shilpa; Justice, Amy C; Alexander, G Caleb et al. (2015) Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy. J Acquir Immune Defic Syndr 69:493-8|
Showing the most recent 10 out of 18 publications