Chronic pain and heavy drinking are common co-occurring conditions among people living with HIV infection (PLWH) each of which have a negative impact on daily functioning and HIV-related outcomes. Moreover, these comorbid conditions have a significant impact on one another. Pain is an important trigger for alcohol use among heavy drinkers and is linked with the experience of negative alcohol-related consequences. Among PLWH, moderate or greater pain has been linked with risky drinking over time. Similarly, problem drinking interferes with pain management efforts among those with chronic pain and is linked to earlier dropout from treatment. Clinicians face a number of challenges in their efforts to address these frequently co-occurring conditions including low patient motivation for change, poor adherence to treatment, and frequent barriers to using pharmacological treatments to adequately treat both conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be readily incorporated into HIV-care settings and easily utilized by patients. Through the UH2/UH3 mechanism the objectives of the proposal are to, 1) develop an integrated behavioral video telehealth intervention approach to reduce pain and alcohol use among heavy drinking HIV-infected patients with chronic pain and determine its feasibility and acceptability (UH2) and 2) obtain effect size estimates of intervention efficacy through a randomized controlled pilot trial (UH3). This study represents a first effort to utilize a video telehealth approach to address alcohol use and pain for patients this setting. The UH2 component will be used for treatment development and initial testing with a small sample of patients in an open pilot. Evidence of patient acceptability and feasibility in this setting along with pre-post changes in identified outcomes will provide data on which to base the UH3 component which will be a preliminary test of intervention efficacy through a randomized controlled pilot trial.
