People living with HIV (PLWH) experience increased risk for all-cause mortality at lower levels of alcohol consumption compared to uninfected individuals and higher levels of alcohol-related problems are found among African Americans despite equivalent or lower drinking. Furthermore, deleterious effects of alcohol on ART adherence and clinical outcomes have been reported in low income urban populations. Moreover, it is recommended that PLWH receive routine alcohol screening, and that evidence-based brief motivational interventions (MI) be employed when they screen positive. Indeed, MI is well-established as efficacious in reducing consumption in a broad range of patients, and adherence-focused MI has been shown to improve adherence among PLWH. While evidence supporting extended interventions targeting both alcohol and adherence is promising, multi-session interventions are generally difficult to implement with high-risk patients and no study has evaluated a single-session MI targeting both. In many HIV settings, there are barriers preventing implementation of even brief MI, such as competing intensive demands, limited resources, and lack of alcohol-specific expertise. Telehealth technology offers a viable solution. Our team has expertise in developing efficacious alcohol-focused MIs and in multi-target MI addressing the intersection of alcohol and sexual risk behavior. Further, we have an emerging understanding of the science of multi-targeted brief intervention, where co-occurring risk behaviors can be intervened upon and their reciprocal associations exploited. In particular, we have proof of concept data supporting a multi- target MI with findings demonstrating reduction in alcohol can further contribute to reductions in sexual risk behavior. We have also demonstrated logistical feasibility and acceptability of using video-conferencing technology to deliver multi-target MI in a demand-intensive setting. This proposal leverages our expertise to deliver a novel, multi-target video-conferenced MI (vMI) to racially diverse PLWH in an inner-city setting. From a translational perspective, process research is a novel means of informing intervention development, particularly when interventions are brief and there are multiple targets. For example, when developing an intervention with 2 intersecting targets for change, it is imperative to examine the ideal salience and sequencing of these targets. In Phase I, we will conduct new analyses on existing therapeutic process data to specifically examine behavioral target salience and sequencing as predictors of outcome in a brief MI with known efficacy in affecting multiple risk behaviors. Results will allow us to optimize salience and sequencing of alcohol and adherence targets in our new multi-target MI developed specifically for reaching high-risk ART non-adherent patients. Phase 1 will translate process research into a treatment-development framework to optimize a multi-target vMI to reduce consumption and increase adherence. Phase II will examine efficacy of a multi-target vMI to reduce consumption and increase adherence among dual-risk PLWH.
By increasing understanding of how interventions to reduce excessive drinking and increase ART adherence can impact HIV-related health outcomes, this UH2/UH3 project can contribute greatly to efforts to improve the health of those living with HIV and to reduce the spread of HIV.