Women account for 1 in 4 people living with HIV (PLWH) in the United States, and while African American (AA) women comprise only 14% of the US female population, they account for greater than 60% of women living with HIV (WLWH). In 2013, the state of Maryland was second only to Washington, DC in the rates of HIV diagnoses among women. Alcohol misuse interrupts critical steps in the HIV prevention and care continuum (HPACC) and thus contributes to significant health disparities among at-risk and WLWH. Our prior work in Baltimore has demonstrated a strong association between alcohol misuse and HIV risk behaviors among at risk and WLWH, poorer retention in HIV care and lower use of and adherence to antiretroviral therapy (ART). We have developed theory-based, in-person and computer-delivered brief interventions (CBI) for at risk and WLWH with alcohol misuse, demonstrating drinking reductions in recent RCTs. However behavioral and structural barriers to optimal uptake of alcohol interventions and engagement in the HPACC remain, including mental health comorbidity and low knowledge, access, and use of HIV prevention practices such as HIV pre- exposure prophylaxis (PrEP). Engaging key stakeholders, including at-risk and WLWH, and community organizations and leaders, is critical to successful implementation of interventions at the intersection of HIV and alcohol misuse among women. The goals of this proposal are two-fold: 1) to build on our current community partnerships to determine how to optimally implement evidence based alcohol treatment for at risk and WLWH in Baltimore, and 2) to determine whether the addition of information, motivational and peer navigator support related to comorbid mental health, and HIV prevention practices can enhance CBI and improve alcohol and HPACC outcomes among at risk and WLWH. To achieve these goals we will use a Community Based Participatory Research (CBPR) approach, engaging patient and community stakeholders during all aspects of study development, and community pilot testing. In collaboration with our Community Advisory Board (CAB), we will: 1) adapt our current CBI with text messaging to address gaps in the HIV prevention and care continuum (CBI-CC). We will conduct focus groups with both at risk and WLWH to tailor intervention manuals, followed by piloting and further feedback and modification. 2) We will conduct a pilot randomized controlled trial (RCT) of CBI-CC + text and peer navigation among 60 at-risk or WLWH with alcohol misuse. Primary outcomes, assessed at 3 and 6 months, include drinking days, heavy drinking days, drinks per drinking day; other outcomes include days of sex without condom use, mental health and substance use treatment engagement, and uptake of HIV prevention practices (HIV testing, PrEP, condoms).Through this U34 planning grant we will partner with key stakeholders in the community to build capacity to deliver effective, evidence-based interventions at the nexus of alcohol and HIV for at risk and WLWH with alcohol misuse, and improve engagement in the HIV prevention and care continuum.
Alcohol misuse is associated with an increased risk for HIV infection, and worse HIV treatment outcomes among women. There are effective interventions to help at risk- and women-living with HIV (WLWH) reduce their alcohol use; however, they still have barriers to optimal HIV prevention and treatment, including 1) depression and stress/trauma and 2) decreased access to and use of HIV prevention services. Working with community stakeholders, including at risk and WLWH, we will determine how best to expand current alcohol interventions to address these barriers, and how to best implement alcohol interventions in the community.
