title: Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement.
abstract: In HIV-infected individuals, non-injection drug use (NIDU) compromises many health outcomes. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce NIDU is unknown, and drug users may need greater intervention. We designed an enhancement to MI, HealthCall (HC), for daily patient self-monitoring calls to an interactive voice response (IVR) phone system, and provided participants with periodic personalized feedback. To reduce NIDU among HIV primary care patients, we compared the efficacy of MI+HealthCall to MI-only and an educational control condition.
  
  
  
  Participants age >18 with >4days of NIDU during the prior 30days were recruited from large urban HIV primary care clinics. Of the 240 participants, 83 were randomly assigned to control, 77 to MI-only, and 80 to MI+HC. Counselors provided educational control, MI-only or MI+HC at baseline. At 30 and 60days (end-of-treatment), counselors briefly discussed drug use, moods and health behaviors, using HealthCall-generated graphs with MI+HC patients. Primary outcomes (last 30days) were number of days used primary drug (NumDU), and total quantity of primary drug used (dollar amount spent; QuantU), derived from the Time-Line Follow-Back.
  
  
  
  Across all groups, at end-of-treatment, frequency and quantity of NIDU decreased, with significantly greater reductions in the MI-Only group. A twelve-month post-treatment follow-up indicated sustained benefits of MI+HC and MI-only relative to control.
  
  
  
  Brief interventions can be successfully used to reduce non-injection drug use in HIV primary care. IVR-based technology may not be sufficiently engaging to be effective. Future studies should investigate mobile technology to deliver a more engaging version of HealthCall to diverse substance abusing populations.
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA. Electronic address: aharono@nyspi.columbia.edu.
authors.forename: Efrat
authors.initials: E
authors.lastname: Aharonovich
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Sarvet
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Malki
authors.initials: M
authors.lastname: Stohl
authors.affiliation: Icahn School of Medicine, at Mount Sinai New York, New York, USA.
authors.forename: Don
authors.initials: D
authors.lastname: DesJarlais
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; HIV Center for Clinical and Behavioral Studies/Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tross
authors.affiliation: Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Hurst
authors.affiliation: Institute for Advanced Medicine, Mount Sinai Health System, New York, NY, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Urbina
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hasin
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D019966:Substance-Related Disorders / Q000517:prevention & control*; D013689:Telephone
keywords: Drug use; HIV; IVR intervention; Motivational interviewing