This application aims to develop and evaluate a theory-driven training for HIV care providers to support their systematic use of the National institute on Alcohol Abuse and Alcoholism's effective brief intervention (NIAAA's Bl) for alcohol reduction. The high rate of at-risk alcohol use among individuals with HIV and HIV/HCV co-infection, and the serious harm that such alcohol use often causes in (a) accelerating disease progression, (b) limiting effectiveness and access to ARV therapy, and (c) sometimes increasing risky sexual behaviors that seriously jeopardize their health and that of their partners, provides the rationale and urgency for this research. Although providers are uniquely positioned to screen and counsel patients about alcohol reduction as part of a """"""""prevention with positive"""""""" focus, they rarely do, often as a result of limited experience, skills, and self-efficacy. Thus, a provider training to implement NIAAA's Bl is critically needed, and, as our preliminary studies indicate, HIV care providers are interested in receiving such a training and indicate they would put the Bl skills they learn into practice. Thus, guided by Social Cognitive Theory and Simpson's Model of Organizational Change, the aims of the proposed developmental study are to (1) create a state-of-the-art provider training to encourage the implementation of NIAAA's Bl by teaching participants (a) how to screen patients for alcohol use, and (b) how to effectively counsel them to reduce this use using the principles of motivational interviewing; (2) to implement the training in 4 Designated AIDS Centers in New York City to obtain preliminary data regarding the impact of the training on providers immediately post-training, and 1- and 4- months post- training with regard to their knowledge, attitudes, self-efficacy, collective organizational efficacy, and actual use of NIAAA's Bl; and (3) to obtain preliminary data in order to examine the impact of the provider training on (a) patients' alcohol reduction; and on (b) the HIV provider organization, in terms of (i) the organizational climate towards dealing with alcohol and HIV and HIV/HCV co-infection; and (ii) the organization's actual expansion of existing alcohol reduction services and/or the implementation of new services to reduce alcohol consumption. If results demonstrate that the training is useful, feasible, acceptable, and effective in filling a critical service gap for HIV patients, we will seek funding to further examine its effectiveness in a variety of venues and to disseminate the training widely. ? ? ? ?
