Brief Intervention Enhanced by Interactive Voice Response Reduces Heavy Drinking among People with HIV and Alcohol Dependence
Heavy alcohol use among HIV-infected patients is associated with worse HIV treatment outcomes and contributes to liver-related mortality. Researchers conducted a 3-arm randomized clinical trial among 258 primary care patients with HIV who reported ≥ 4 drinks at least once in the previous 30 days. The 3 arms were:
- Motivational Interview (MI)+HealthCall: A 20–25 minute MI followed by 60 days of daily patient self-monitoring and 1–3 minute phone calls to an automated telephone system that provided personalized feedback on alcohol use.
- MI-only: A 20–25 minute MI.
- Control: Feedback that drinking was more than recommended, pamphlet detailing alcohol reduction techniques, and a 30-minute HIV self-care video with no alcohol-related content.
All 3 groups received 5–10 minute counselor booster sessions at 30 and 60 days. The primary outcome was mean number of drinks per day.
- Of the sample, 48% had current alcohol dependence.
- The MI+HealthCall group completed a median 64% of self-monitoring calls.
- At 60 days, the mean number of drinks per day in the MI+HealthCall, MI-only, and Control groups was 3.58, 3.94, and 4.75, respectively. Among the alcohol-dependent subgroup, the mean number of drinks per day was 3.55, 5.12, and 6.07. Among the non-dependent subgroup, mean number of drinks per day ranged from 3.03 to 3.64 and no differences were significant.
- At 3, 6, and 12 months, the mean number of drinks per day was no longer significantly different in the overall sample or the dependent or non-dependent subgroups.
This trial is the first to suggest that a brief intervention appears to be effective, though only in the very short term, for people with HIV and alcohol dependence. Paradoxically, no benefit was observed in non-dependent drinkers. Enhancement of brief interventions with daily brief automated alcohol use assessment and feedback warrants study in more settings, populations, and for varying lengths of time.Alexander Y. Walley, MD, Msc