Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement

Aims In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients. Design Parallel random assignment to control (n=88), MI-only (n=82) or MI+HealthCall (n=88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients. Setting Large urban HIV primary care clinic. Participants Patients consuming 4 drinks at least once in prior 30 days. Measurements Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days. Findings End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model 2, d.f.=9.11,2, P=0.01). For contrasts of NumDD, P=0.01 for MI+HealthCall versus control; P=0.07 for MI-only versus control; and P=0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P<0.01 for MI+HealthCall versus control; P=0.09 for MI-only versus control; and P=0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant. Conclusions For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.