TALC

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Project Abstract Alcohol use disorders, substance use disorders, and mental health comorbidities are a major threat to ending the HIV epidemic. This is especially the case in Alabama and other priority states within the U.S. ‘Ending the HIV Epidemic’ initiative. Addressing unhealthy alcohol use and mental health comorbidities in the Deep South is made difficult by poverty and lack of public health services. Because of the similar challenges in low-resource settings, interventions developed for low and middle-income countries (LMIC) hold promise for reducing unhealthy alcohol use in people living with HIV (PLWH) in Alabama and improving psychosocial comorbidities that disproportionately impact this population. Designed to address the limited mental health workforce in LMIC, Common Elements Treatment Approach (CETA) is a promising treatment for unhealthy alcohol use and mental health comorbidities in Alabama. CETA is a multi-session cognitive behavioral therapy-based intervention that employs transdiagnostic techniques to address comorbid alcohol use, other substance use, and mental health symptoms through a single provider. CETA has been proven effective in at least 7 LMICs, with specific support for reducing depressive symptoms and unhealthy alcohol misuse. The proposed study is a randomized trial, Telemedicine for unhealthy Alcohol use in persons Living with HIV using CETA (TALC study), to achieve the following aims: 1) Evaluate the effectiveness of T-CETA on unhealthy alcohol use among PLWH, 2) Evaluate the effectiveness of T-CETA on HIV outcomes, 3) Evaluate the effectiveness of T-CETA on SUD and mental health comorbidities, and 4) Evaluate implementation factors related to BI and T-CETA provision to people with HIV unhealthy alcohol use in care at community clinics in Alabama including feasibility, acceptability, cost and cost-effectiveness. PLWH (n = 308) from community-based HIV clinics in Alabama will be enrolled in the trial. Patients will be eligible if they self-report unhealthy alcohol use on a validated tool (AUDIT), which is assessed every 4-6 months as part of routine care. Participants will be randomized 1:1 to a brief alcohol intervention (BI) versus BI plus T-CETA (n = 154 per arm). This is one of two program projects aiming to test the effectiveness of CETA on unhealthy alcohol use, mental health comorbidities, and HIV outcomes among PLWH residing in underserved areas. If the project aims are achieved, it will significantly advance our understanding of strategies to reduce HIV disease progression and transmission in Alabama and advance the President’s Plan to End the HIV Epidemic. Following achievement of these aims, we plan to conduct a multi-site implementation study to address barriers identified in the implementation assessment (Aim 4) and translate study findings into routine community care in other priority states for reducing HIV across the Southern U.S.