Among HIV-infected individuals, drinking can interfere with antiretroviral treatment and with treatment of HCV among those co-infected. Further, end-stage liver disease is now a common cause of mortality in HIV patients, so managing unsafe drinking in this group is crucial to their care. The goal of this study (responding to NIAAA PA-02-039) is to test the efficacy of a drinking-reduction intervention in HIV primary care patients. The intervention has two components. One is a brief motivational interview (Ml), an evidence-based intervention often used in primary care. The other, HealthCall, was created to enhance Ml effects. HealthCall involves daily 1-3 minute calls to a toll-free telephone interactive voice response system. User-friendly questions in English or Spanish ask branching questions about drinking and other health concerns in the prior 24 hours. Patients input responses by voice or telephone touchpad. Monthly, they receive feedback: a bar graph generated from the HealthCall database displaying their daily drinking in the prior 30 days, discussed with their Ml counselor. Pilot work in a large, low-SES HIV primary care clinic demonstrated feasibility and suggested efficacy; this clinic and another will be the sites of the study. Ml and MI+HealthCall will be studied among 348 patients randomly assigned to three groups. Group 1, controls, will view a 30- minute DVD on self-care and latest developments in HIV. Group 2 will receive a 30-minute Ml adapted for HIV patients. Group 3 will receive the 30-minute Ml plus HealthCall. All groups will receive NIAAA pamphlets. Follow-up will be at 3, 6 and 12 months. Primary outcomes are drinking quantity and frequency. Mediators of intervention effects on drinking (motivation and self-efficacy)and secondary health outcomes will be explored. Analysis will include marginal linear models for repeated measures using GEE estimation. Successful results would contribute to effective, sustainable drinking-reduction interventions in HIV-infected individuals to promote their long-term health, and to adaptation of the innovative model for other important outcomes.
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