title: Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Large urban HIV primary care clinic.
  
  
  METHODS
  Patients consuming ≥4 drinks at least once in prior 30 days.
  
  
  METHODS
  Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days.
  
  
  RESULTS
  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.
authors: Department of Psychiatry, Columbia University, New York, NY, USA. dsh2@columbia.edu
authors: Deborah S
authors: DS
authors: Hasin
authors: Efrat
authors: E
authors: Aharonovich
authors: Ann
authors: A
authors: O'Leary
authors: Eliana
authors: E
authors: Greenstein
authors: Martina
authors: M
authors: Pavlicova
authors: Srikesh
authors: S
authors: Arunajadai
authors: Rachel
authors: R
authors: Waxman
authors: Milton
authors: M
authors: Wainberg
authors: John
authors: J
authors: Helzer
authors: Barbara
authors: B
authors: Johnston
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D011614:Psychotherapy, Brief / Q000379:methods*; D016896:Treatment Outcome