Brief Acceptance and Commitment Therapy for HIV-Infected At-Risk Drinkers

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Abstract Alcohol consumption at hazardous levels is associated with negative consequences on nearly every step of the HIV care continuum. It is a critical factor in HIV treatment that, if unaddressed, significantly contributes to onward transmission and poor treatment outcomes. Alcohol interventions for people living with HIV (PLWH) in the United States (US) have shown mixed results, and no alcohol intervention for PLHW has shown long-term reductions in heavy drinking or a significant impact on HIV-related outcomes. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co- morbid mental health conditions, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, making it a promising approach for hazardous drinkers. The overall objective of this application is to adapt an existing brief ACT intervention developed for smoking cessation, and pilot test its feasibility and acceptability for PLWH who are hazardous drinkers. We hypothesize that the resulting intervention will be preliminarily associated with decreased alcohol use, improved ART adherence, decreased symptoms of depression, anxiety, and drug use, and increased acceptance—a known mechanism of change in ACT. The specific aims are as follows: Aim 1—we will adapt an existing brief ACT intervention for HIV-infected hazardous drinkers (ACT-AU). We will accomplish this aim by: Modifying a 5-session, telephone-delivered ACT intervention for smoking cessation via iterative multidisciplinary team meetings, focus group discussions with HIV clinic patients (N = 15-20), and qualitative interviews with HIV clinic providers (N = 5-10). Aim 2—we will conduct a pilot comparative effectiveness randomized clinical trial (RCT) of ACT-AU compared to a brief alcohol intervention previously shown to reduce drinking days among HIV-infected women. We will accomplish this aim by: Randomly assigning N = 74 HIV-infected hazardous drinkers (50% women) to the intervention developed in Aim 1, or a brief alcohol intervention similar in length and frequency of treatment sessions. We will assess feasibility, acceptability, and preliminary trial outcomes. Alcohol use and ART adherence will be assessed via both self-report and biomarkers at 6-weeks and 6-months post-randomization; preliminary changes in acceptance as well as symptoms of anxiety and depression, and drug use will also be examined 6- weeks and 3 and 6-months post-randomization. The proposed research will provide essential pilot data for a R01 application to conduct a full-scale RCT to determine the comparative efficacy of ACT-AU.