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Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial

  • Edelman, E. Jennifer1, 2
  • Maisto, Stephen A.3
  • Hansen, Nathan B.2, 4
  • Cutter, Christopher J.1
  • Dziura, James5
  • Deng, Yanhong5
  • Fiellin, Lynn E.1, 2
  • O’Connor, Patrick G.1
  • Bedimo, Roger6
  • Gibert, Cynthia L.7
  • Marconi, Vincent C.8
  • Rimland, David8
  • Rodriguez-Barradas, Maria C.9
  • Simberkoff, Michael S.10
  • Tate, Janet P.1, 11
  • Justice, Amy C.1, 11
  • Bryant, Kendall J.12
  • Fiellin, David A.1, 2
  • 1 Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA , New Haven (United States)
  • 2 Yale School of Public Health, New Haven, CT, 06510, USA , New Haven (United States)
  • 3 Syracuse University, Syracuse, NY, 13244, USA , Syracuse (United States)
  • 4 University of Georgia, Athens, GA, 30602, USA , Athens (United States)
  • 5 Yale University School of Public Health, New Haven, CT, 06511, USA , New Haven (United States)
  • 6 Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX, 75216, USA , Dallas (United States)
  • 7 Washington University School of Medicine and Health Sciences, Washington, D.C, 20422, USA , Washington (United States)
  • 8 Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA , Atlanta (United States)
  • 9 Michael E. DeBakey VAMC and Baylor College of Medicine, Texas Houston, Houston, TX, 77030, USA , Houston (United States)
  • 10 VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY, 10010, USA , New York (United States)
  • 11 VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA , West Haven (United States)
  • 12 National Institute On Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA , Bethesda (United States)
Published Article
Addiction Science & Clinical Practice
BioMed Central
Publication Date
Jul 29, 2020
DOI: 10.1186/s13722-020-00200-y
Springer Nature


BackgroundAt-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use.MethodsIn this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol consumption of ≥ 14 drinks per week or ≥ 4 drinks per occasion in men ≤ 65 years old or ≥ 7 drinks per week or ≥ 3 drinks per occasion in women or men > 65 years old]. ISAT (n = 46) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 47) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat principles.ResultsDespite a multi-pronged approach, we only recruited 37% of the target population (n = 93/254). Among ISAT participants, 50% advanced to Step 2, among whom 57% advanced to Step 3. Participants randomized to ISAT and TAU had no observed difference in drinks per week over the past 30 days at week 24 (primary outcome) [least square means (Ls mean) (95% CI) = 8.8 vs. 10.6; adjusted mean difference (AMD) (95% CI) = − 0.4 (− 3.9, 3.0)].ConclusionAn insufficient number of patients were interested in participating in the trial. Efforts to enhance motivation of PWH with at-risk alcohol use to engage in alcohol-related research and build upon ISAT are needed.Trial registration NCT01410123, First posted August 4, 2011

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