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Monday, February 25, 2013

Reducing Heavy Drinking in HIV Primary Care: A Randomized Trial of Brief Intervention, with and without Technological Enhancement





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.

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.

Large urban HIV primary care clinic.

Patients consuming ≥4 drinks at least once in prior 30 days.

Using TimeLine FollowBack, primary outcome was number of drinks per drinking day, last 30 days.

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 X2,df=9.11,2, p=.01). For contrasts of NumDD, p=.01 for MI+HealthCall vs. control; p=.07 for MI-only vs. control; and p=.24 for MI+HealthCall vs. 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<.01 for MI+HealthCall vs. control; p=.09 for MI-only vs. control; and p=.03 for MI+HealthCall vs. 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.

For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.
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