Hazardous alcohol use among PWID who are living with HIV is independently associated with decreased ART adherence and viral suppression 13 as well as sharing needles and/or syringes, having multiple sex partners, and engaging in sex without condoms. Hazardous and heavy alcohol use in specific subpopulations of PWH, including people who inject drugs (PWID), may place them at even higher risk for health consequences due to comorbidities as well as transmission of HIV and other infections. 7, 14 - 16 Despite the known adverse health consequences of alcohol use, there is a lack of evidence-based interventions for PWH, 17 - 21 and hazardous and heavy alcohol consumption are frequently not addressed in HIV health care settings. 13 Alcohol use is also associated with elevated sexual and injection risk behaviors that increase the likelihood of HIV transmission. 3 - 9 Alcohol use has been associated with decreased adherence to antiretroviral therapy (ART) 10 - 12 and decreased viral suppression. 2 In low-income and middle-income countries, hazardous alcohol use among PWH is common, with 20% to 46% of PWH reporting hazardous alcohol use. 1 In a large multisite clinical cohort of PWH in the United States, 27% reported hazardous alcohol use and 34% reported binge drinking. Hazardous alcohol use is highly prevalent among people living with HIV (PWH). Trial Registration Identifier: NCT02720237 Future implementation science studies evaluating scale-up of the brief intervention are needed. Viral suppression (ie, <20 copies of HIV-1 RNA per milliliter) at 12 months was higher after the brief intervention than SOC (difference, 11% 95% CI, 2% to 20%), but the difference between the combined intervention and SOC was not significantly different (difference, 5% 95%, CI, –5% to 15%).Ĭonclusions and Relevance In this study, the brief intervention resulted in a significant increase in percentage of days abstinent from alcohol and a significant increase in viral suppression after 12 months. At 12 months, the mean (SE) percentage of days abstinent was 65% (3.1%) among those in the combined intervention group, 65% (3.2%) among those in the brief intervention group, and 50% (3.4%) among those in the in the SOC group (Cohen d for combined intervention vs SOC and brief intervention vs SOC: 39% 95% CI, 15% to 64%). In the combined intervention group, 112 participants (76.2%) attended all 6 sessions, and in the brief intervention group, 124 (84.4%) attended all 4 sessions in the whole sample, 390 (88.6%) completed 12 months of follow-up. Results A total of 440 eligible individuals (mean age, 40.2 years 426 men) were enrolled 147 (33.4%) were assigned to the combined intervention, 147 (33.4%) to the brief intervention, and 146 (33.2%) to SOC. Main Outcomes and Measures The primary study outcomes were percentage of days abstinent from alcohol, confirmed using the alcohol biomarker phosphatidylethanol, and viral suppression at 12 months after enrollment. Interventions Participants were randomly assigned (1:1:1) to standard of care (SOC), a combined intervention of motivational enhancement therapy and cognitive behavioral therapy (6 in-person sessions of 1 hour each and 3 optional group sessions), or a brief intervention with similar components as the combined intervention but consisting of 2 shorter in-person sessions and 2 telephone sessions. Data were collected from March 2016 to May 2018 and analyzed from June 2018 to February 2020. Adults receiving ART with hazardous alcohol use (Alcohol Use Disorders Identification Test–Consumption score ≥4 for men or ≥3 for women) and no plans to leave Thai Nguyen were included. Objective To compare the efficacy of 2 scalable ART clinic–based interventions on alcohol use and viral suppression.ĭesign, Setting, and Participants This 3-group randomized clinical trial was conducted among 440 adults with HIV who were being treated at 7 ART clinics in Thai Nguyen, Vietnam. Importance Hazardous and heavy alcohol use is common among people living with HIV and may decrease antiretroviral therapy (ART) adherence, but limited data exist from randomized clinical trials about the effects of interventions on viral load. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.
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