Reducing Heavy Drinking in HIV Primary Care: a Randomized Trial of Brief Intervention, with and Without Technological Enhancement

Overview

Journal Addiction

Specialty Psychiatry

Date 2013 Feb 26

PMID 23432593

Citations 88

Authors

Deborah S Hasin

Efrat Aharonovich

Ann OLeary

Eliana Greenstein

Martina Pavlicova

Srikesh Arunajadai

Rachel Waxman

Milton Wainberg

John Helzer

Barbara Johnston

Affiliations

Soon will be listed here.

Abstract

Aims: 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.

Design: 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.

Setting: Large urban HIV primary care clinic.

Participants: Patients consuming ≥4 drinks at least once in prior 30 days.

Measurements: Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days.

Findings: 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 χ(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.

Conclusions: For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.

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