Hazardous alcohol use is prevalent among HIV infected individuals, and is associated with decreased antiretroviral therapy uptake, adherence, and virologic suppression. Unfortunately, patient engagement and retention in traditional alcohol treatment services is poor. Screening, brief alcohol intervention, and referral to treatment (SBIRT) has been shown to be effective in reducing hazardous alcohol use and improving health- related outcomes in primary care and emergency room settings. In addition to SBIRT, there are several FDA-approved pharmacotherapies with demonstrated efficacy in reducing alcohol consumption. Providing intervention at the point-of-care through SBIRT in HIV clinics offers an excellent opportunity for integration of brief alcohol intervention and alcohol pharmacotherapy. Utilizing the CFAR Network of Integrated Clinical Systems (CNICS), a national network comprised of 8 clinical cohorts and over 20,000 HIV-infected individuals across the US, we will examine the effectiveness of a computer-delivered brief intervention as well as a an HIV provider pharmacotherapy training to prescribe alcohol treatment medications delivered in the HIV clinical care setting. All CNICS patients will be screened for hazardous or binge drinking and individuals with positive screens will be administered the computerized brief intervention (CBI) at their first visit. At the second visit (approximately 3 months later), participants who continue to screen positive will receive either another session of CBI or will be offered CBI and alcohol pharmacotheray (CBl+APT). All participants will be followed for an additional 6 months to determine alcohol reduction and HIV-related outcomes. It is expected that CBl+APT will be more effective than CBI alone, while CBI alone will be more effective than standard of care for reducing hazardous drinking and improving HIV-related outcomes. Further, we will examine patient-related predictors of engagement and retention in care and determine barriers to successful integration of these interventions in the HIV clinical care setting. Finally, cost- effectiveness analyses will be conducted to determine the impact of these interventions in this setting.

Public Health Relevance

As patients with HIV are living longer, it is important to provide treatment to reduce hazardous alcohol use which impacts HIV disease progression and quality of life. Providing these interventions at HIV clinics is an important strategy to increase engagement in alcohol treatment and improve HIV-related outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AA020802-03
Application #
8529402
Study Section
Special Emphasis Panel (ZAA1-DD (04))
Program Officer
Roach, Deidra
Project Start
2011-09-10
Project End
2016-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
3
Fiscal Year
2013
Total Cost
$448,598
Indirect Cost
$39,431
Name
University of Alabama Birmingham
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
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