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

Document Type

Article

Publication Date

1-1-2025

Publication Title

Journal of Acquired Immune Deficiency Syndrome

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.

First Page

72

Last Page

81

PubMed ID

39321757

Volume

98

Issue

1

Link to Full Text

Share

COinS