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Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial.

ABSTRACT: OBJECTIVE:Hazardous alcohol use by HIV-infected women is associated with poor HIV outcomes and HIV transmission risk behaviors. We examined the effectiveness of brief alcohol intervention (BI) among hazardous drinking women receiving care in an urban HIV clinic. METHODS:Women were randomized to a 2-session BI or usual care. Outcomes assessed at baseline, 3, 6, and 12 months included 90-day frequency of any alcohol use and heavy/binge drinking (?4 drinks per occasion), and average drinks per drinking episode. Secondary outcomes included HIV medication and appointment adherence, HIV-1 RNA suppression, and days of unprotected vaginal sex. We examined intervention effectiveness using generalized mixed-effect models and quantile regression. RESULTS:Of 148 eligible women, 74 were randomized to each arm. In mixed-effects models, 90-day drinking frequency decreased among intervention group compared with control, with women in the intervention condition less likely to have a drinking day (odds ratio: 0.42; 95% confidence interval: 0.23 to 0.75). Heavy/binge drinking days and drinks per drinking day did not differ significantly between groups. Quantile regression demonstrated a decrease in drinking frequency in the middle to upper ranges of the distribution of drinking days and heavy/binge drinking days that differed significantly between intervention and control conditions. At follow-up, the intervention group had significantly fewer episodes of unprotected vaginal sex. No intervention effects were observed for other outcomes. CONCLUSIONS:BI reduces frequency of alcohol use and unprotected vaginal sex among HIV-infected women. More intensive services may be needed to lower drinks per drinking day and enhance care for more severely affected drinkers.

SUBMITTER: Chander G

PROVIDER: S-EPMC4634011 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial.

Chander Geetanjali G Hutton Heidi E HE Lau Bryan B Xu Xiaoqiang X McCaul Mary E ME

Journal of acquired immune deficiency syndromes (1999) 20151001 2

<h4>Objective</h4>Hazardous alcohol use by HIV-infected women is associated with poor HIV outcomes and HIV transmission risk behaviors. We examined the effectiveness of brief alcohol intervention (BI) among hazardous drinking women receiving care in an urban HIV clinic.<h4>Methods</h4>Women were randomized to a 2-session BI or usual care. Outcomes assessed at baseline, 3, 6, and 12 months included 90-day frequency of any alcohol use and heavy/binge drinking (≥4 drinks per occasion), and average ...[more]

PMID: 25967270

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Project description:In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients.Parallel random assignment to control (n = 88), MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients.Large urban HIV primary care clinic.Patients consuming ?4 drinks at least once in prior 30 days.Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days.End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model ?(2) , d.f.?= 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control; P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant.For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.

Project description:Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested.To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking.A randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N?=?600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n?=?242), assessed control (n?=?237), or no-contact control (n?=?121).A 20- to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months.Incidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system.Of 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels.For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting.clinicaltrials.gov Identifer: NCT01207258.

Project description:IntroductionHeavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their HIV care. Although brief interventions to reduce heavy drinking in primary care are effective, more extensive intervention may be needed in PLWH with moderate-to-severe alcohol use disorder. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed the "HealthCall" app to provide continued engagement after brief intervention, reduce drinking, and improve other aspects of HIV care with minimal demands on providers. We conducted a randomized trial of its efficacy.MethodsThe study recruited alcohol-dependent PLWH (n = 114) from a large urban HIV clinic. Using a 1:1:1 randomized design, the study assigned patients to: Motivational Interviewing (MI) plus HealthCall (n = 39); NIAAA Clinician's Guide (CG) plus HealthCall (n = 38); or CG-only (n = 37). Baseline MI and CG interventions took ~25 min, with brief (10-15 min) 30- and 60-day booster sessions. HealthCall involved daily use of the smartphone app (3-5 min/day) to report drinking and health in the prior 24 h. Outcomes assessed at 30 and 60 days and at 3, 6 and 12 months included drinks per drinking day (DpDD; primary outcome) and number of drinking days, analyzed with generalized linear mixed models and pre-planned contrasts.ResultsStudy retention was excellent (85%-94% across timepoints). At 30 days, DpDD among patients in MI + HealthCall, CG + HealthCall, and CG-only was 3.80, 5.28, and 5.67, respectively; patients in MI + HealthCall drank less than CG-only and CG + HealthCall (IRRs = 0.62, 95% CI = 0.46, 0.84, and 0.64, 95% CI = 0.48, 0.87, respectively). At 6 months (end-of-treatment), DpDD was lower in CG + HealthCall (DpDD = 4.88) than MI + HealthCall (DpDD = 5.88) or CG-only (DpDD = 6.91), although these differences were not significant. At 12 months, DpDD was 5.73, 5.31, and 6.79 in MI + HealthCall, CG + HealthCall, and CG-only, respectively; DpDD was significantly lower in CG + HealthCall than CG-only (IRR = 0.71, 95% CI = 0.51, 0.98).ConclusionsDuring treatment, patients in MI + HealthCall had lower DpDD than patients in other conditions; however, at 12 months, drinking was lowest among patients in CG + HealthCall. Given the importance of drinking reduction and the low costs/time required for HealthCall, pairing HealthCall with brief interventions merits widespread consideration.

Project description:This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians' use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians' use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.

Dataset Information

Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial.

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Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial.

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