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Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement
Author(s) -
Hasin Deborah S.,
Aharonovich Efrat,
O'Leary Ann,
Greenstein Eliana,
Pavlicova Martina,
Arunajadai Srikesh,
Waxman Rachel,
Wainberg Milton,
Helzer John,
Johnston Barbara
Publication year - 2013
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12127
Subject(s) - motivational interviewing , medicine , brief intervention , heavy drinking , primary care , randomized controlled trial , psychological intervention , intervention (counseling) , human immunodeficiency virus (hiv) , emergency medicine , family medicine , injury prevention , poison control , psychiatry
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.