Integrated stepped alcohol treatment with contingency management for unhealthy alcohol use among people with HIV: A randomized controlled trial.

Edelman EJ, Dziura J, Deng Y, DePhilippis D, Ferguson T, Brown S, Marconi VC, Goetz MB, Rodriguez-Barradas MC, Simberkoff MS, Molina PE, Weintrob AC, Maisto SA, Paris M, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment with contingency management for unhealthy alcohol use among people with HIV: A randomized controlled trial. Journal of acquired immune deficiency syndromes (1999). 2024 Sep 25.

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Abstract:

BACKGROUND: We examined the impact of integrated stepped alcohol treatment with contingency management (ISAT+CM) on alcohol abstinence among people with HIV (PWH) and unhealthy alcohol use. METHODS: In this multisite 24-week trial, we randomized PWH reporting untreated unhealthy alcohol use and with phosphatidylethanol (PEth) > 20ng/mL to receive ISAT+CM or treatment as usual (TAU). Intervention: Step 1: Social worker-delivered CM; Step 2: Addiction physician management plus motivational enhancement therapy. Participants were advanced to step 2 at week 12 if they lacked evidence of abstinence over the prior 21 days. TAU: Health handout, and for those who met criteria for alcohol use disorder, a referral to substance use treatment. Primary outcome: self-reported abstinence over the past 21 days at week 24. RESULTS: We enrolled 120 PWH between January 5, 2018 and March 1, 2022. Mean age was 59 years, 96% were men, and 83% were Black. Eight percent were lost to follow-up. In the ISAT+CM group, 87% were advanced to Step 2. The posterior mean proportion of participants with self-reported abstinence at 24 weeks was higher among those randomized to ISAT+CM (posterior mean proportion 9% [95%CrI, 0%, 33%]) compared with TAU (posterior mean proportion 0.3 % [95%CrI, 0%, 4%]) (posterior mean treatment effect 9%, [95%CrI, 1%, 32%], the posterior probability of TAU being superior to ISAT+CM was < 0.0001. DISCUSSION: ISAT+CM delivered in HIV clinics modestly increased self-reported 3-week abstinence among PWH. Our findings indicate a need for more effective treatments to promote abstinence and a potential role for ISAT+CM for reductions in alcohol use.