Alcohol Use & HIV: Developing Computerized Interventions

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DESCRIPTION (provided by applicant): Alcohol use and hazardous drinking have significant implications for the clinical management and health outcomes of HIV positive patients. Alcohol use in HIV positive patients is believed to be associated with increased morbidity and mortality, more rapid disease progression, poorer adherence to antiretroviral regimens, and greater risk of viral resistance. Despite this risk, HIV providers do not accurately identify alcohol use and hazardous drinking. The long-term objective of this developmental R21 proposal is to improve the detection and management of hazardous drinking in HIV clinical settings, thereby reducing long term health and economic consequences. One (1) method to achieve this objective is through brief interventions (BIs). BIs are simple treatments that vary from brief advice to a short motivational interview and persuade drinkers to reduce their alcohol intake to low risk levels and consequently reduce medical complications and resource use. Computer technology offers a promising and understudied method of delivering Bis in the healthcare setting. This application will combine Bis with state-of-the-art computer technology to deliver patient-specific recommendations based on clinical guidelines. The specific aims of this developmental project are: 1) To adapt and test a computer alcohol screening and Bl prototype ("the prototype") using an iterative, qualitative process of user testing, focus groups, and face-to-face interviews with providers and HIV positive patients; 2) To test the feasibility of implementing the prototype, assess potential barriers to alcohol screening and intervention (e.g., complexity of medication regimen, social issues, etc.) and gather data on enrollment rates in two Department of Veterans Affairs HIV clinics; 3) To test whether the intervention is associated with a decrease in alcohol consumption 90 days post-BI in HIV positive patients who screen positive for hazardous drinking. This exploratory/developmental proposal will produce a field-tested intervention and dependable estimates for sample size, recruitment rate, and number of sites needed for a randomized clinical trial.