Alcohol Use Disorders (AUDs) and hazardous drinking are the fourth leading cause of preventable death in the US and are responsible for 10% of all deaths among working age adults. Among Persons Living with HIV/AIDS (PLWH), heavy alcohol use is up to twice the rate in the general population. Few people engage in behavioral alcohol treatment and alcohol pharmacotherapies are not routinely used as part of alcohol treatment, despite the known efficacy of these interventions. PLWH engaged in treatment for their HIV disease have regular contact with a medical provider and are treated in a medical home model in which all medical services are delivered within HIV clinics, but few HIV providers feel comfortable treating AUDs. During our initial funding period, we implemented routine alcohol screening, developed a computerized brief intervention (CBI), and conducted provider training on alcohol pharmacotherapies. However, while we found a strong impact from routine screening with CBI for reducing alcohol use, few providers prescribed alcohol pharmacotherapy, despite this specialized training, with most indicating continued discomfort and lack of knowledge for use of pharmacotherapy. Algorithms are used routinely to guide providers in treatment selection for many different disorders that are not within their specialty such as diabetes management, obesity, arthritis, and other disorders. In addition, we tested the use of provider algorithms for the treatment of depression and smoking with PLWH and demonstrated increased utilization of these medications. For this renewal, we are proposing an implementation science test of using an algorithm that will build upon our success with CBI and integrate alcohol pharmacotherapies and other behavioral therapies within routine treatment. A decision-tree algorithm that provides more intensive treatments, including alcohol pharmacotherapies, that is also responsive to comorbidities such as depressive or anxiety symptoms will be tested in three HIV clinics across CFAR Network of Integrated Clinical Systems (CNICS). Primary outcomes include reduced alcohol consumption and frequency, improved HIV outcomes, and improvement in comorbid conditions. We will also examine provider, staff, patient, and clinic-level facilitators and barriers to implementation of this algorithm in routine clinical care. Successful implementation of this treatment approach would have considerable impact on reducing AUDs among PLWH and could be integrated within existing electronic health record systems for a sustainable model of alcohol treatment delivery to other HIV clinics.
Hazardous alcohol use is the fourth leading cause of preventable death in the United States and is up to twice as high among PLWH. Algorithms have been developed to increase the efficacy of the treatment of chronic diseases with tremendous success but have never been empirically tested to aid in alcohol use disorders (AUDs). We propose to test an algorithm developed to aid providers in selecting behavioral and pharmacotherapy for the treatment of AUDs for PLWH engaged in care.
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