Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV

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PROJECT SUMMARY/ABSTRACT Unhealthy drinking and chronic pain are common co-occurring conditions among people living with HIV (PLWH) each of which negatively influences physical and mental functioning, HIV-related outcomes, and one another. Health care providers face a number of challenges to addressing these frequently co-occurring conditions for PLWH including restricted time and resources, limitations of pharmacological treatments to adequately treat both conditions (particularly among those with other co-occurring medical conditions or substance use histories), and poor patient adherence to recommended non-pharmacological treatments. Although there are empirically-supported behavioral approaches to address the full spectrum of each of these conditions, they often require multiple session, in-person interventions. Such requirements are burdensome to PLWH, who may face stigma and considerable economic challenges regarding transportation, child-care, and missed work. These challenges are compounded when considering treatments for multiple conditions. Given the rates of chronic pain and heavy drinking among PLWH, their combined impact on daily functioning and HIV-outcomes, and available treatment limitations, there would be considerable benefit to an integrative behavioral approach to address these comorbid conditions in a manner that may be easily utilized by patients. In our prior work, we have developed an integrated behavioral video telehealth intervention designed to reduce unhealthy alcohol use and chronic pain among PLWH. This intervention, Motivational and Cognitive Behavioral Treatment for the Management of Alcohol Use and Pain (MCBMAP) is a 7-session integrated intervention that is delivered through telehealth and supplemented with materials available on a website. The intervention, which was tailored for PLWH based on qualitative interviews, has been shown to have high patient acceptability and be readily delivered through smartphones. The current study seeks to test the efficacy of this intervention for reducing unhealthy drinking and chronic pain in a fully-scaled, randomized controlled trial among PLWH that compares MCBMAP to a Brief Advice and Information condition at 6-month outcomes. In addition, this project will examine moderators and mediators of intervention through self-report questionnaires and through the use of ecological momentary assessment (EMA) conducted before and after treatment. These EMA methods will allow us to examine how the processes through which the intervention may reduce unhealthy drinking and pain as well as provide insight into the association between pain, unhealthy drinking, and functional outcomes in this population.