Non-injection drug use (NIDU) is common among people with HIV and can lead to poor health outcomes. Brief motivational interviewing (MI) provides a framework for HIV primary care clinicians to discuss reductions of NIDU with patients, but prior studies suggest that brief interventions alone do not result in reductions in use. In this randomized trial, researchers investigated an enhancement to MI, HealthCall (HC), a tool that allows for daily patient self-monitoring calls to an interactive voice response (IVR) phone system with periodic personalized feedback. Participants (N=240) age ≥18 with ≥4 days of NIDU during the prior 30 days were assigned to control (n=83), MI-only (n=77; 30-minute intervention with a trained counselor and 2 10–15 minute booster sessions at 30 and 60 days), or MI + HC (n=80).
- 16% of the sample met DSM-IV criteria for substance dependence; the primary drug of choice was crack for 50%; and the mean number of days of use in the 30 days prior to baseline was 8.
- Treatment retention at 60 days was: 89% (MI +HC), 82% (MI), and 78% (control) with no differences between the groups. Excellent rates of retention persisted at 12 months.
- At the end of treatment (60 days), there were no significant differences in decreases in the number of days of primary drug used or dollar amount spent on primary drug; however, at 6 and 12 months, both were lower in the MI group (incidence rate ratio for days 0.49 and 0.54, respectively at 6, and 0.50 and 0.45, respectively at 12 months) but not the MI + HC group compared with the control group. Unadjusted days of drug use decreased from approximately 8-9 days at baseline (and $15) to 3 days (<$5) in the MI group, and to 4 days (and $7-9) in the MI + HC and control groups.
Comments: This study shows that among patients enrolled in primary HIV care who reported low-severity drug use, motivational interviewing (MI) groups, with or without phone-based self-monitoring, and control groups all reported decreased drug use, with no differences between intervention and control at 60 days. Self-reported drug use was reduced at 6 and 12 months for those assigned to MI only but not to MI plus self-monitoring. Although MI is expected to have an effect, it is surprising that self-monitoring did not. Given multiple comparisons in this study, and prior large null randomized trials of brief intervention for drug use, these findings might be viewed as hypothesis generating and requiring replication.
Jeanette M. Tetrault, MD
Reference: Aharonovich E, Sarvet A, Stohl M, et al. Reducing non-injection drug use in HIV primary care: a randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement. J Subst Abuse Treat. 2017;74:71–79.