We propose a theory-based intervention designed to improve HIV medication adherence and reduce alcohol use among an ethnically diverse sample of male and female HIV seropositive (HIV+) persons with alcohol-related problems. The intervention will be evaluated within existing HIV clinic settings in New York City. Eligible participants will be HIV+, have detectable viral loads at baseline, be on an HIV medication regimen, and demonstrate alcohol-related problems (e.g., dependence, abuse, problem drinking). The overall goal for the proposed study is to test an intervention with medically meaningful and behaviorally desirable outcomes, so that the intervention can be easily disseminated and integrated into other HIV clinics providing comprehensive care for HIV+ persons with alcohol problems. In addition, we will examine the mediating and moderating influences on intervention success. The proposed intervention utilizes Motivational Interviewing and Cognitive-Behavioral Skills Training and is delivered by a combination of a counselor and medical care provider and builds upon the previous work of the investigators who have conducted formative research on the adherence issues among HIV+ persons. Using the Information-Motivation-Behavioral Skills (IMB) model, the intervention is designed to impact knowledge and understanding of HIV medication regimens, motivation to adhere, and skills related to adherence. Further, the intervention aims to promote knowledge and understanding of the dangers of alcohol use for HIV+ persons, motivation to reduce drinking, and skills related to changing alcohol use behaviors. The intervention consists of eight sessions and will be compared to an attention control condition. Eligible participants will be referred by their clinic providers and will be randomized to one of two conditions: (1) treatment - the eight session theory-based intervention; or (2) comparison - eight sessions of standard care education. Participants will complete assessments t baseline, and at 3-, 6-, 9-, 12-, and 15-month follow-ups in order to assess short-term and long-term effects. We propose to use biological markers (viral load, CD4 count, and CDT testing for alcohol use) as primary outcome measures, supplemented with self-reported adherence, prescription refill data (via pharmacy records), adherence to medical appointments (via chart review), and self-reported alcohol use and alcohol related problems. Multivariate repeated measures analyses and growth curve modeling, using both continuous and dichotomous outcome variables, will be used to assess the impact of the intervention on both adherence and alcohol use.
