Individuals with HIV face serious risks from heavy drinking, including decreased immune function, poor medication adherence, and risk for liver damage, now a leading cause of mortality in HIV. For individuals with both HIV and hepatitis C virus (HCV), heavy drinking is particularly hazardous, as it limits HCV treatment and exacerbates liver damage. However, despite increasing recognition of the harms associated with drinking in HIV/HCV, little research has investigated possible explanations for this risky behavior, and no interventions exist specifically to reduce heavy drinking in HIV/HCV co-infected patients, who face the highest risk. In this K23 application, I propose a training and research program that will enable me to begin pursuing my long-term goal of advancing understanding and ability to intervene with heavy drinking in the high-risk group of patients with HIV and HCV. My training will focus on HIV and HCV (the diseases, co-infection, and treatment), clinical trials in medical populations, and biostatistics. I will obtain this training through courses and seminars offered by Columbia University Medical Center, as well as regular meetings with expert mentors and consultants. I will use this training to address short-term goals: to investigate factors underlying heavy drinking among patients with HIV (Aim 1a) and HIV/HCV (Aim 1b); to adapt and pilot test a drinking-reduction intervention for HIV/HCV co-infected patients (Aim 2), incorporating information from Aims 1a and 1b; and to develop an R01 proposal for a full clinical trial.
For Aim 1 a, I will use data from a large clinical trial to invetigate factors underlying heavy drinking among HIV patients. Applying drinking motive constructs from the larger alcohol literature that I have already validated in HIV patients, I will investigate the relationship between motives for drinking and abstaining and drinking outcomes in two different timeframes: as reported daily for 60 days, and from pre-intervention to 12 month follow-up. I will also investigate whether motives for drinking and abstaining change due to intervention. Further, I will investigate whether HIV patients in neighborhoods with permissive drinking norms differ from other patients on drinking, drinking motives, and response to intervention.
For Aim 1 b, I will use data from a large cross-sectional study of drug users to determine whether drinking differs by patient perceptions of health status and HIV and HCV severity.
For Aim 2, I will adapt and pilot test an existing brief, technology- enhanced drinking-reduction intervention for HIV patients to be suitable for HIV/HCV co-infected patients. For this, I will incorporate findings fro Aims 1a and 1b, content from effective interventions for liver disease patients, and input from HIV primary care providers and patients. I will pilot test this intervention, and based on pilot results, design an R01 application for a full clinical trial for co-infected patients. This researc, which is only feasible through the training, research, and protected time offered by a K23 career development award, has strong potential to advance the understanding and ability to intervene with heavy drinking in HIV/HCV patients, a very hazardous behavior that poses substantial risks to patients' long-term survival.

Public Health Relevance

Among patients with HIV, especially those also infected with Hepatitis C Virus (HCV), heavy drinking is associated with significant risks to health and survival; however, little is known about what leads some HIV/HCV-infected patients to drink heavily despite these substantial risks, and how to best intervene among these heavy drinkers. I propose to examine several motivational and social factors likely to underlie heavy drinking in these patients, to better understand why some engage in a behavior so detrimental to their health and to provide information that can inform the design of improved interventions. I also propose to develop and test the first drinking-reduction intervention for patients with both HIV and HCV, in order to enhance our ability to intervene with this high-risk behavior of critical importance to the health and survival of this patient population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23AA023753-01
Application #
8847110
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Freeman, Robert
Project Start
2015-02-15
Project End
2020-01-31
Budget Start
2015-02-15
Budget End
2016-01-31
Support Year
1
Fiscal Year
2015
Total Cost
$186,192
Indirect Cost
$13,792
Name
New York State Psychiatric Institute
Department
Type
DUNS #
167204994
City
New York
State
NY
Country
United States
Zip Code
10032
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
Dyar, Christina; Taggart, Tenille C; Rodriguez-Seijas, Craig et al. (2018) Physical Health Disparities Across Dimensions of Sexual Orientation, Race/Ethnicity, and Sex: Evidence for Increased Risk Among Bisexual Adults. Arch Sex Behav :
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
Gause, Nicole K; Elliott, Jennifer C; Delker, Erin et al. (2018) Association between change in self-efficacy to resist drinking and drinking behaviors among an HIV-infected sample: Results from a large randomized controlled trial. J Health Psychol 23:829-839
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
Thompson Jr, Ronald G; Elliott, Jennifer C; Hu, Mei-Chen et al. (2017) Short-term effects of a brief intervention to reduce alcohol use and sexual risk among homeless young adults: Results from a randomized controlled trial. Addict Res Theory 25:24-31
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
Elliott, Jennifer C; Delker, Erin; Wall, Melanie M et al. (2016) Neighborhood-Level Drinking Norms and Alcohol Intervention Outcomes in HIV Patients Who Are Heavy Drinkers. Alcohol Clin Exp Res 40:2240-2246

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