HIV-infected patients with unhealthy alcohol use are not often motivated to decrease their alcohol consumption and rarely receive treatment for their drinking. To address these challenges, we plan to provide treatment in HIV clinics, highlight to patients the impact alcohol can have on their medical conditions, and use Contingency Management (CM) with a stepped care design to adjust treatment to patient response. CM is an evidence- based therapy that promotes abstinence from substance use, including alcohol. Since CM has not been studied for unhealthy alcohol use in HIV-infected patients we will include a stepped care strategy that provides Addiction Psychiatrist Management (APM) (with alcohol pharmacotherapies as indicated) and Motivational Enhancement Therapy (MET) for patients who do not achieve abstinence with CM. Phosphatidylethanol (PEth), is a validated biomarker that can confirm alcohol abstinence over three weeks. To capture the range of adverse effects of alcohol on health, we will include patients with at-risk drinking, alcohol use disorder, and medical conditions that can be adversely impacted by alcohol including those with a detectable HIV viral load, tobacco use disorder, liver fibrosis, untreated hepatitis C, depression and those taking psychoactive medications that interact with alcohol. The goal of the Financial Incentives, Randomization with Stepped Treatment (FIRST) Trial is to compare onsite CM plus stepped care versus treatment as usual (TAU) in a randomized clinical trial of 348 HIV-infected patients with unhealthy alcohol use at seven HIV clinics. CM patients will receive onsite CM counseling sessions adminstered by a Social Worker with financial rewards contingent on abstinence demonstrated by breathalyzer and PEth. Rewards can also be awarded for addressing medical conditions impacted by alcohol and achieving alcohol treatment goals. After three months, patients will be stepped up to APM and MET if PEth results indicate they have not attained abstinence. This randomized clinical trial will test the hypothesis that CM plus stepped care leads to greater abstinence, decreased alcohol consumption and improved HIV biomarkers as measured by the VACS Index. Data analyses will be conducted on the intention to treat sample of patients. The primary outcome is the proportion of individuals with PEth documented abstinence at six months. Secondary outcomes include alcohol consumption assessed using Timeline Followback, and change in the VACS Index. Novel aspects of this proposal include: 1) The first evaluation of CM for unhealthy alcohol use in HIV clinics, 2) An assessment of onsite CM plus stepped care including APM and MET, 3) Use of PEth to guide CM rewards and as a trial outcome, 4) Addressing patient motivation with CM and a focus on medical conditions impacted by alcohol, 5) Use of the VACS Index, a validated biomarker that reflects overall health and abstinence among HIV-infected patients receiving addiction treatment. This study, conducted by experienced HIV and addiction researchers, will determine the efficacy of CM plus stepped care in HIV-infected patients with unhealthy alcohol use.

Public Health Relevance

Untreated alcohol problems threaten the health of people who are infected with the HIV virus and are a major cause of illness and death. The goals of this study are to optimize the treatment of HIV disease by decreasing alcohol consumption, improving HIV immune markers, and improving overall health in patients with unhealthy alcohol use. The current project will serve to advance this area of research and expand the types of care that HIV-infected patients receive.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AA020795-10
Application #
10003118
Study Section
Special Emphasis Panel (ZAA1)
Program Officer
Roach, Deidra
Project Start
2011-09-15
Project End
2021-08-31
Budget Start
2020-09-01
Budget End
2021-08-31
Support Year
10
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Williams, Emily C; McGinnis, Kathleen A; Bobb, Jennifer F et al. (2018) Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort. Drug Alcohol Depend 189:21-29
Halpin, Sean N; Carruth, Edwin Clayton; Rai, Ramona P et al. (2018) Complementary and Alternative Medicine Among Persons living with HIV in the Era of Combined Antiretroviral Treatment. AIDS Behav 22:848-852
Matson, Theresa E; McGinnis, Kathleen A; Rubinsky, Anna D et al. (2018) Gender and alcohol use: influences on HIV care continuum in a national cohort of patients with HIV. AIDS 32:2247-2253
Barry, Declan T; Marshall, Brandon D L; Becker, William C et al. (2018) Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care. Drug Alcohol Depend 191:348-354
Justice, Amy C; Gordon, Kirsha S; Skanderson, Melissa et al. (2018) Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. AIDS 32:739-749
Rentsch, Christopher T; Cartwright, Emily J; Gandhi, Neel R et al. (2018) Provider verification of electronic health record receipt and nonreceipt of direct-acting antivirals for the treatment of hepatitis C virus infection. Ann Epidemiol 28:808-811
Bensley, Kara M; McGinnis, Kathleen A; Fortney, John et al. (2018) Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas. J Rural Health :
Korthuis, P Todd; Edelman, E Jennifer (2018) Substance use and the HIV care continuum: important advances. Addict Sci Clin Pract 13:13
Khan, Maria R; McGinnis, Kathleen A; Grov, Christian et al. (2018) Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US. AIDS Care :1-8
Adams, Joƫlla W; Bryant, Kendall J; Edelman, Jennifer E et al. (2018) Association of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men. AIDS Behav 22:1341-1351

Showing the most recent 10 out of 34 publications