Alcohol Research Consortium in HIV: Relapse Prevention Arm

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At risk alcohol use and alcohol use disorders (AUD) are prevalent among people with HIV (PWH) and cause well-documented harms across the HIV prevention and care continuum. A number of effective person and computer delivered alcohol treatments exist for PWH; however, to date they have largely focused on at- risk alcohol use and do not address the sizeable population of PWH with AUD who are at risk of relapse. Indeed, in the general population, approximately 50-75% of people who stop drinking alcohol relapse within one year, indicating that relapse is a significant part of the alcohol use spectrum. Relapse prevention interventions (RPI) potentially extend the alcohol care continuum by building skills to reduce frequency and intensity of relapse episodes, maintain treatment engagement, and motivate renewed efforts toward drinking reduction. Thus, there is a high clinical need to investigate RPI effectiveness to maintain drinking reductions in PWH and, if effective, to integrate RPI into HIV-CC. We propose a 3-arm type 1 pilot implementation-efficacy trial for PWH with AUD to examine the feasibility and preliminary effectiveness of an adapted 2-session, computerized and person delivered relapse prevention intervention. Our proposed pilot is a NIH Stage 1 Model for behavioral intervention development that defines Stage 1A as intervention adaptation and refinement for new patient groups and settings, and Stage 1B as intervention piloting to test preliminary effectiveness and feasibility/acceptability. Our project has three phases. First, we will adapt a relapse prevention intervention for PWH, train the interventionist for person-delivered administration, and use authoring software to develop the computerized administration. Second, we will recruit and randomize 150 patients who have an AUD diagnosis and who are at risk for alcohol relapse from a large, urban HIV clinic. The three study conditions are computer delivered RPI, person delivered RPI or treatment as usual. Alcohol and HIV outcomes will be assessment for one-year. Third, we will use the RE-AIM implementation framework to evaluate study participants, and clinical and organizational staff with mixed methods to assess barriers and facilitators to RPI integration in the HIV clinical setting. To our knowledge this is the first avatar delivered, evidence-driven intervention developed for alcohol relapse prevention in HIV patients. For long-term success in Ending the HIV Epidemic, it is critical that the alcohol treatment field expand types of clinical services and availability/ease of access within the HIV care continuum. In the future, this will enable a personalized medicine approach to care that more precisely and intensively targets those patients at highest risk of relapse, and thereby optimizes health and quality of life for PWH with AUD.