Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement

Abstract

Aims: 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.

Design: 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.

Setting: Large urban HIV primary care clinic.

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

Measurements: Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days.

Findings: 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.

Trial registration: ClinicalTrials.gov NCT00371969.

Figure 1

Sample personalized patient feedback graph given to patients in motivational interviewing (MI)+HealthCall arm at 30 and 60 days, based on the drinking they reported in calls to HealthCall

Figure 2

Flow of study participants. Study of HealthCall enhancement of motivational interviewing for drinking reduction: New York City HIV primary care patients with at-risk drinking (≥4 drinks on at least one occasion in past 30 days) at baseline; patients enrolled August 2007–May 2010

Figure 3

Mean drinks per drinking day to end of treatment (60 days), by treatment group, among whole sample. ^aEducation/advice (control) n: 0 days = 88; 30 days = 87; 60 days = 87. ^bMotivational interviewing (MI)-only n: 0 days = 82; 30 days = 78; 60 days = 78. ^cMI+HealthCall n: 0 days = 84; 30 days = 78; 60 days = 75

Figure 4

Mean drinks per drinking day to end of treatment (60 days), by treatment group, alcohol-dependent patients. ^aEducation/advice (control) n: 0 days = 41; 30 days = 41; 60 days = 41. ^bMotivational interviewing (MI)-only n: 0 days = 39; 30 days = 37; 60 days = 36. ^cMI+HealthCall n: 0 days = 43; 30 days = 39; 60 days = 38

Figure 5

Mean drinks per drinking day to end of treatment (60 days), by treatment group, non-alcohol-dependent patients. ^aEducation/advice (control) n: 0 days = 47; 30 days = 46; 60 days = 46. ^bMotivational interviewing (MI)-only n: 0 days = 43; 30 days = 41; 60 days = 42. ^cMI+HealthCall n: 0 days = 41; 30 days = 39; 60 days = 37

Figure 6

Mean drinks per drinking day during follow-up period, by treatment group. ^aEducation/advice (control) n: 90 days = 86; 180 days = 86; 360 days = 87. ^bMotivational interviewing (MI)-only n: 90 days = 77; 180 days = 77; 360 days = 76. ^cMI+HealthCall n: 90 days = 75; 180 days = 75; 360 days = 74. ^dSee Table S3 for number of patients (Ns), by treatment group, at all follow-up time-points