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Randomized Controlled Trial
. 2025 Jan 1;98(1):72-81.
doi: 10.1097/QAI.0000000000003534.

Integrated Stepped Alcohol Treatment With Contingency Management for Unhealthy Alcohol Use Among People With HIV: A Randomized Controlled Trial

E Jennifer Edelman  1   2   3 , James Dziura  4   5 , Yanhong Deng  4 , Dominick DePhilippis  6   7 , Tekeda Ferguson  8   9 , Sheldon Brown  10 , Vincent C Marconi  11 , Matthew Bidwell Goetz  12 , Maria C Rodriguez-Barradas  13 , Michael S Simberkoff  14 , Patricia E Molina  9   15 , Amy C Weintrob  16 , Stephen A Maisto  17 , Manuel Paris  18 , Amy C Justice  2   19 , Kendall J Bryant  20 , David A Fiellin  1   2   3   5
Affiliations
Randomized Controlled Trial

Integrated Stepped Alcohol Treatment With Contingency Management for Unhealthy Alcohol Use Among People With HIV: A Randomized Controlled Trial

E Jennifer Edelman et al. J Acquir Immune Defic Syndr. .

Abstract

Background: We examined the impact of integrated stepped alcohol treatment with contingency management (ISAT + CM) on alcohol abstinence among people with HIV (PWH) and unhealthy alcohol use.

Methods: In this multisite 24-week trial, we randomized PWH reporting untreated unhealthy alcohol use and with phosphatidylethanol (PEth) >20 ng/mL to receive ISAT+CM or treatment as usual (TAU). Intervention : Step 1 : Social worker-delivered CM; Step 2 : Addiction physician management plus motivational enhancement therapy. Participants were advanced to step 2 at week 12 if they lacked evidence of abstinence over the prior 21 days. TAU : Health handout, and for those who met criteria for alcohol use disorder, a referral to substance use treatment. Primary outcome: self-reported abstinence for the past 21 days at week 24.

Results: We enrolled 120 PWH between January 5, 2018, and March 1, 2022. Mean age was 59 years, 96% were men, and 83% were Black. Eight percent were lost to follow-up. In the ISAT+CM group, 87% were advanced to Step 2. The posterior mean proportion of participants with self-reported abstinence at 24 weeks was higher among those randomized to ISAT+CM [posterior mean proportion 9% (95% credible interval [CrI]: 0%-33%)] compared with TAU [posterior mean proportion 0.3% (95% CrI: 0%-4%)] [posterior mean treatment effect 9%, (95% CrI: 0%-32%)], the posterior probability of TAU being superior to ISAT + CM was <0.0001.

Discussion: ISAT + CM delivered in HIV clinics modestly increased self-reported 3-week abstinence among PWH. Our findings indicate a need for more effective treatments to promote abstinence and a potential role for ISAT + CM for reductions in alcohol use.

Trial registration: Clinicaltrials.gov (NCT03089320).

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References

    1. Duko B, Ayalew M, Ayano G. The prevalence of alcohol use disorders among people living with HIV/AIDS: a systematic review and meta-analysis. Subst Abuse Treat Prev Pol. 2019;14:52.
    1. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. 2005;352:596–607.
    1. Justice AC, McGinnis KA, Tate JP, et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend. 2016;161:95–103.
    1. Edelman EJ, Maisto SA, Hansen NB, et al. Integrated stepped alcohol treatment for patients with HIV and alcohol use disorder: a randomised controlled trial. Lancet HIV. 2019;6:e509–e517.
    1. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. Department of Health and Human Services; https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult... (2024, October 16, 2024).

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