Novel Extensions of Alcohol Contingency Management in People Living with HIV

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PROJECT SUMMARY Alcohol misuse in people living with HIV (PLWH) is a public health issue given relationships to cognitive and physical effects, which may subsequently accelerate HIV progression, increase likelihood of transmission and hasten related comorbidities. Thus, efficacious interventions to reduce alcohol use in PLWH are needed. Specifically, contingency management (CM; tangible reinforcement to change behavior) has been efficacious for alcohol intervention in the general population, but there are no published studies focused on testing CM for alcohol misuse in PLWH. Our current project testing 30-day CM including a subsample of PLWH (U01 AA020797) has promising preliminary findings. Despite its efficacy, remaining concerns about CM typically relate to long-term feasibility given financial costs or the possibility that negative behaviors will return when reinforcement ends. Thus, there is a need for approaches to extend CM beyond a limited period and make this approach amenable to wide dissemination. In this proposed P01 component project (N=120), we will implement several innovations to address feasibility concerns with an eye to research using implementation science methods in community health centers and clinics. Our novel approach will marshal mobile health (mHealth) capabilities, alcohol biosensors and gamification, which may enhance engagement through social connections and friendly competition. We will extend our current CM research by enrolling a wider range of participants regarding drinking behavior, age and comorbidities in a 30-day CM induction period. Bio- confirmation will be based on smartphone breath alcohol readings with identity confirmation. Our findings indicate the majority of PLWH avoid heavy drinking for at least 30 days with CM but a considerable minority do not, making prediction of outcome based on key baseline characteristics important. After 30 days, participants will be engaged in a motivational interview (MI) including personalized feedback based on reductions in alcohol use, enhanced cognitive and/or physical functioning. Following the 30-day CM induction and MI, responders will be randomized to 1 of 3 conditions to inform progress toward disseminable CM: 1) CM with intermittent reinforcement, plus novel, mHealth-based gamification; 2) CM with intermittent reinforcement without gamification; 3) or non-contingent reinforcement (control condition). In this innovative, second 30-day period, reinforcement will be based on wrist biosensor not breath alcohol readings and on a weekly rather than daily basis including reinforcement for bio-confirmed drinking moderation, not only abstinence. Follow-up will occur at 60, 90 and 180 days. Primary aims will test the magnitude of increases in percent days abstinent during the 30-day CM induction and baseline predictors of outcome (e.g., drinking severity, executive function). We will also test alcohol abstinence as a predictor of cognitive, biological and HIV outcomes. In addition, we will compare acceptability and preliminary efficacy across the 3 study conditions during the second, 30-day CM period. This project is an initial step to implement affordable, technology-based CM for alcohol in PLWH.