With advances in treatment, people living with HIV/AIDS (PLWHA) have greatly improved survival rates and medical outcomes. However, despite the increased availability of highly-active antiretroviral therapy, many PLWHA fail to take their medication as directed. This reduces their chances of achieving viral suppression and is thus a crucial component of the HIV/AIDS treatment cascade. To improve the outcomes of PLWHA and address the low levels of viral suppression observed nationwide, it is essential to examine factors that are likely to decrease medication adherence. One such factor is alcohol consumption, which has been shown to have a significant and large effect on whether or not individuals follow their medication regimen. The primary objective of this research is to develop and test an alcohol reduction intervention for PLWHA. Based on collaborators? previous research and prior literature, this eight-week intervention, titled Tracking and Reducing Alcohol Consumption (TRAC), will be delivered entirely using technology. Counselors will meet with patients using videoconferencing in partnership with the Georgia Department of Public Health?s Telehealth Network, as well as via phone-based conversations. This technology-based delivery will be highly accessible to patients in both rural and urban areas of Georgia, as it requires only two in-person visits to a local health department office for videoconferencing sessions. As a supplement to the intervention, participants will also engage in self-monitoring of alcohol consumption and medication adherence through mobile questionnaires and Bluetooth-enabled breathalyzers. The use of mobile breathalyzers represents an innovative application of modern technologies and has potential to improve the validity of self-reported alcohol consumption. Overall, the TRAC intervention will be developed and tested in two stages: an open trial (N=10) exploring acceptance and usability, and a small randomized pilot trial (N=60) assessing feasibility and evidence for efficacy in regard to reducing alcohol consumption, increasing medication adherence, and improving medical outcomes.
I aim to receive comprehensive training to support this line of research related to reducing alcohol consumption among PLWHA. As part of my training plan, five mentors who specialize in HIV/AIDS, alcohol, intervention design, telemedicine, and advanced data analysis will provide guidance through directed readings, regular meetings, and feedback on research design. These mentors are located at the University of Georgia and Yale University. Both universities will provide me with access to extensive intellectual resources and partnering organizations who can aid in my research, including the Georgia Department of Public Health, Yale?s Center for Interdisciplinary Research on AIDS, and the NIAAA Consortia for HIV/AIDS and Alcohol-Related Research Trials. I will also participate in courses and workshops related to clinical data analysis, HIV/AIDS research, and behavioral intervention design. This training will provide me with the foundation needed to meet my long-term goal of conducting an externally-funded program of research in HIV/AIDS and alcohol and drug use.
While advances in medication have led to greatly improved outcomes for people living with HIV/AIDS, less than one-third of all people living with the disease are adherent enough to their medication to achieve viral suppression. Alcohol consumption has been shown to have a significant effect on HIV medication adherence, so the proposed research will aim to reduce alcohol use among people living with HIV/AIDS through a technology-driven intervention. This eight-session intervention will be delivered using a combination of videoconferencing, smartphones, and Bluetooth-enabled breathalyzers for monitoring of alcohol consumption, with an overall goal of reducing alcohol use, mitigating adherence issues, and achieving optimal prevention and treatment responses for people living with HIV/AIDS.