title: HIV primary care providers--Screening, knowledge, attitudes and behaviors related to alcohol interventions.
abstract: BACKGROUND
  Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown.
  
  
  METHODS
  We conducted a cross-sectional survey of HIV providers from 8 HIV clinical sites across the United States. Surveys queried knowledge and use of alcohol screening, brief advice, counseling and pharmacotherapy, confidence and willingness to prescribe pharmacotherapy and barriers to their use of alcohol pharmacotherapy. We used multivariable logistic regression to examine provider factors associated with confidence and willingness to prescribe pharmacotherapy.
  
  
  RESULTS
  Providers (N=158) were predominantly female (58%) and Caucasian (73%); almost half were infectious disease physicians and 31% had been in practice 10-20 years. Most providers (95%) reported always or usually screening for alcohol use, although only 10% reported using a formal screening tool. Over two-thirds never or rarely treated alcohol-dependent patients with pharmacotherapy themselves. Most (71%) referred alcohol-dependent patients for treatment. Knowledge regarding alcohol pharmacotherapy was low. The major barrier to prescribing pharmacotherapy was insufficient training on use of pharmacotherapy. Provider confidence ratings were positively correlated with their practice patterns.
  
  
  CONCLUSIONS
  HIV providers reported high rates of screening for alcohol use, though few used a formal screening tool. Most providers referred alcohol dependent patients to outside resources for treatment. Few reported prescribing alcohol pharmacotherapy. Increased training on alcohol pharmacotherapy may increase confidence in prescribing and use of these medications in HIV care settings.
authors: Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: Gchande1@jhmi.edu.
authors: Geetanjali
authors: G
authors: Chander
authors: Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: amonroe4@jhmi.edu.
authors: Anne K
authors: AK
authors: Monroe
authors: Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States. Electronic address: hcrane@uw.edu.
authors: Heidi M
authors: HM
authors: Crane
authors: Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: hhutton@jhmi.edu.
authors: Heidi E
authors: HE
authors: Hutton
authors: Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL. 1720 7th Ave S., Birmingham, AL 35294-0017, United States. Electronic address: msaag@uab.edu.
authors: Michael S
authors: MS
authors: Saag
authors: Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 7th Ave S., Birmingham, AL 35294-0017, United States. Electronic address: kcropsey@uab.edu.
authors: Karen
authors: K
authors: Cropsey
authors: Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States. Electronic address: joseph_eron@med.unc.edu.
authors: Joseph J
authors: JJ
authors: Eron
authors: Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States. Electronic address: ebq@med.unc.edu.
authors: E Byrd
authors: EB
authors: Quinlivan
authors: Department of Medicine, University of California at San Francisco, 1001 Potrero Ave, SFGH 80, San Francisco, CA 94110, United States. Electronic address: genge@php.ucsf.edu.
authors: Elvin
authors: E
authors: Geng
authors: Department of Medicine, University of California San Diego, 200 W Arbor Dr # 140, San Diego, CA 92103, United States. Electronic address: cmathews@ucsd.edu.
authors: William Christopher
authors: WC
authors: Mathews
authors: Department of Medicine, Harvard University School of Medicine, Mass Fenway Community Health Ctr, 1340 Boylston St, Boston, MA 02215, United States. Electronic address: sboswell@fenwayhealth.org.
authors: Stephen
authors: S
authors: Boswell
authors: Department of Medicine-Infectious Diseases, Case Western Reserve University, 111000 Euclid Ave, Cleveland, OH 44106, United States.
authors: Benigno
authors: B
authors: Rodriquez
authors: Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: Ellison@jhmi.edu.
authors: Megan
authors: M
authors: Ellison
authors: Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States. Electronic address: kitahata@uw.edu.
authors: Mari M
authors: MM
authors: Kitahata
authors: Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States. Electronic address: rdmoore@jhmi.edu.
authors: Richard D
authors: RD
authors: Moore
authors: Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: mmccaul1@jhmi.edu.
authors: Mary E
authors: ME
authors: McCaul
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000628:therapy*; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014481:United States
keywords: Alcohol screening; Confidence; Education; HIV; Knowledge