Implementation of Computer-delivered Brief Alcohol Intervention in HIV Clinical Settings: Who Agrees to Participate?
OBJECTIVE
Addressing alcohol use in primary HIV settings can improve medical outcomes and overall quality of life of persons living with HIV (PLWH). In order to assess the feasibility of computer-delivered brief alcohol intervention (CBI) and to inform future efforts to improve access to CBI, we examined patient-level socio-demographic, clinical and behavioral characteristics associated with agreement to participate in CBI among non-treatment seeking PLWH with alcohol misuse.


METHODS
Participants were recruited from two Centres for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics. PLWH completed a clinical assessment of patient-reported measures and outcomes using tablet-based assessments, including socio-demographic and behavioural characteristics. HIV biological indicators, i.e., CD4 count and viral load, were also available from the electronic medical record. Participants were approached for CBI participation based on scores on the Alcohol Use Disorders Identification Test (AUDIT); no incentives were offered for CBI participation. We performed chi-square tests, analysis of variance and multivariate logistic regression to compare socio-demographic, behavioural and clinical factors among participants who agreed to participate compared with those who refused/postponed participation.


RESULTS
We observed that 42% of non-treatment seeking, non-incentivized PLWH with alcohol misuse provided written agreement to participate in on-site CBI delivered in their HIV primary care clinic. A larger proportion of PLWH who agreed to enrol in CBI had detectable viral loads, heavier weekly alcohol use, and higher DSM-5 alcohol use disorder symptom counts and mental health symptoms. Neither socio-demographic background nor drug use status was associated with CBI enrolment.


CONCLUSIONS
CBI implementation reached those patients most in need of care. The findings of this study may assist HIV-care providers to better identify appropriate patients and initiate discussions to facilitate the participation of PLWH in alcohol intervention services.
Department of Health, Behaviour and Society, Johns Hopkins Bloomberg School of Public Health Baltimore, USA.
Cui
C
Yang
Department of Medicine, University of Washington Seattle, USA.
Heidi M
HM
Crane
Department of Psychiatry and Behavioural Neurobiology, University of Alabama at Birmingham, USA.
Karen
K
Cropsey
Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine Baltimore, USA.
Heidi
H
Hutton
Department of General Internal Medicine, Johns Hopkins University School of Medicine Baltimore, USA.
Geetanjali
G
Chander
Department of Medicine, University of Alabama at Birmingham, USA.
Michael
M
Saag
Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine Baltimore, USA.
Mary E
ME
McCaul
Alcohol misuse; Brief intervention; HIV; Implementation; Mental health