Addressing alcohol misuse in HIV prevention and care: The Brown University Alcohol Research Center on HIV (ARCH)

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Overall Project Summary Alcohol misuse impacts the depth and breadth of the HIV epidemic, both domestically and globally, through multiple pathways—increasing sexual risk behaviors, reducing adherence to antiretroviral therapy, and increasing the risk for HIV-associated comorbidities and mortality. To reduce the incidence of HIV, approaches must be developed that concurrently address alcohol misuse in the context of HIV testing and behavioral and biomedical prevention approaches. Likewise, to increase rates of HIV viral suppression and reduce HIV-related comorbidities, alcohol misuse must be addressed effectively in diverse populations across a spectrum of HIV care settings. The Brown University Alcohol Research Center on HIV (ARCH) has been supporting collaborative research to develop scalable alcohol-HIV interventions, including video counseling, telehealth, and web-enabled applications, that can be delivered broadly and efficiently using centralized personnel and technological resources. This application to renew the Brown ARCH is organized around the central theme that in order to achieve population impact, interventions addressing alcohol misuse in HIV prevention and care need to be evaluated with an emphasis on real-world effectiveness, scalability, and sustainability, according to the principles of implementation science. Specifically, we propose three projects that leverage our unique strengths in (a) training professionals in alcohol misuse interventions, (b) utilizing video counseling and telehealth as scalable means of reaching populations and providing continuing care, and (c) utilizing behavioral intervention technologies to provide alcohol interventions and ongoing support for change. Research Component 1 (MPI: Wray and Monti) extends our work on the role of alcohol use in HIV transmission among men who have sex with men (MSM) by testing the effectiveness of a web-based intervention that addresses both alcohol use and sex risk in MSM completing HIV self-testing. Research Component 2 (PI: Kahler) extends our work on behavioral telehealth interventions to reduce alcohol misuse in HIV-infected MSM by testing our previously developed video counseling and text messaging interventions in a diverse sample of patients in HIV care at four large, urban federally-qualified health centers. Research Components 1 and 2 share a Hybrid Type 1 effectiveness-implementation trial design, providing data on real-world effectiveness while gathering data related to implementation to inform future studies. Research Component 3 (MPI: Becker and Kuo) complements these projects by conducting an implementation trial that evaluates a cascading training model to promote alcohol screening and brief intervention across HIV care settings in South Africa. Together, these projects—supported by an Administrative Core, Research Methods Core, and Program Advisory Committee and complemented by an outstanding training program in alcohol-HIV research with robust pilot funding opportunities—will make a substantial impact in translating basic and applied knowledge on alcohol and HIV into scalable approaches to reducing the negative impact of alcohol misuse on HIV prevention and care.