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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA013556-05
Application #
6947741
Study Section
Special Emphasis Panel (ZAA1-CC (24))
Program Officer
Bryant, Kendall
Project Start
2001-09-30
Project End
2007-08-31
Budget Start
2005-09-01
Budget End
2007-08-31
Support Year
5
Fiscal Year
2005
Total Cost
$653,659
Indirect Cost
Name
Hunter College
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
620127915
City
New York
State
NY
Country
United States
Zip Code
10065
Longmire-Avital, Buffie; Holder, Catherine A; Golub, Sarit A et al. (2012) Risk factors for drinking among HIV-positive African American adults: the depression-gender interaction. Am J Drug Alcohol Abuse 38:260-6
Longmire-Avital, Buffie; Golub, Sarit A; Parsons, Jeffrey T (2010) Self-reevaluation as a critical component in sustained viral load change for HIV+ adults with alcohol problems. Ann Behav Med 40:176-83
Parsons, Jeffrey T; Rosof, Elana; Mustanski, Brian (2008) Medication adherence mediates the relationship between adherence self-efficacy and biological assessments of HIV health among those with alcohol use disorders. AIDS Behav 12:95-103
Parsons, Jeffrey T; Rosof, Elana; Mustanski, Brian (2008) The temporal relationship between alcohol consumption and HIV-medication adherence: a multilevel model of direct and moderating effects. Health Psychol 27:628-37
Parsons, Jeffrey T; Rosof, Elana; Mustanski, Brian (2007) Patient-related factors predicting HIV medication adherence among men and women with alcohol problems. J Health Psychol 12:357-70
Parsons, Jeffrey T; Golub, Sarit A; Rosof, Elana et al. (2007) Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr 46:443-50