Comparing the Effectiveness of Two Alcohol+Adherence Interventions for HIV+ Youth
Trial Snapshot
- Phase
- Not Applicable
- Sponsor
- Wayne State University
- Enrollment
- 400
- Locations
- 1
- Primary Endpoint
- Change in Alcohol Use from Baseline to 9 months post intervention
Study Overview
Brief Summary
Alcohol use among persons with HIV exacerbates health problems and accelerates HIV disease progression. Antiretroviral therapy (ART) is the single most important treatment for people living with HIV. However, ART adherence is suboptimal among adolescents and young adults living with HIV, the age group with the fastest growing rates of HIV infection, and great risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical setting and be delivered by community health workers (CHW: already members of the HIV care team). The study population will consist of YLH, ages 16-24, who are current patients at 5 ATN sites. Site staff will recruit potential participants. Youth will be randomized to receive Healthy Choices, either clinic-based or home-based delivered by the same CHW in both conditions. Outcomes are measured at baseline, 4-, 7-, and 13-months. Data collection for biological measures will be through medical record extraction, and self-reported measures will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on an iPad. All intervention sessions will be audio-recorded for MITI fidelity coding, and investigators will support local supervisors during the active intervention phase. We will conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of the trial to obtain information about barriers and facilitators of implementation. Thus, the proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to pilot a sustainable model of MI implementation in real-world youth care settings towards the goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care settings; 2) gathering information about who responds under what contexts; and 3) increasing our understanding of the barriers and facilitators for future implementation. The primary hypothesis is that YLH receiving home-based MET will have greater improvements in alcohol use and viral load than YLH receiving clinic-based MET.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 16 Years to 24 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •HIV-infected
- •Ability to speak and understand English
- •Prescribed antiretroviral therapy
- •Detectable viral load in the last month
Exclusion Criteria
- •Not fluent in English
- •History of sever learning disability, mental retardation, major psychiatric disorders (e.g., schizophrenia, bipolar disorder, major depression with psychotic features, etc).
- •Participation in another adherence intervention trial
- •On ART due to pregnancy
Arms & Interventions
Healthy Choices: MET CHW Clinic
The 4-session Motivational Enhancement Therapy (MET) intervention will address alcohol use and HIV medication (ART) adherence. Sessions will be delivered in the CLINIC by a CHW (outreach worker, etc) already providing services in the clinic. The intervention is based on Motivational Interviewing (MI) techniques, building motivation for change by eliciting and reinforcing change talk.
Intervention: Motivational Enhancement Therapy (MET) (Behavioral)
Healthy Choices: MET CHW Home
The 4-session Motivational Enhancement Therapy (MET) intervention will address alcohol use and HIV medication (ART) adherence. Sessions will be delivered in the HOME by a CHW (outreach worker, etc) already providing services in the clinic. The intervention is based on Motivational Interviewing (MI) techniques, building motivation for change by eliciting and reinforcing change talk.
Intervention: Motivational Enhancement Therapy (MET) (Behavioral)
Outcomes
Primary Outcomes
Change in Alcohol Use from Baseline to 9 months post intervention
Time Frame: Baseline, 4-, 7-, and 13-months
We will use multiple methods of assessing use including calendar-based interview, biomarker, and self-report questionnaire.
Change in Viral Load from Baseline to 9 months post intervention
Time Frame: Baseline, 4-, 7-, and 13-months
Viral load will be extracted from medical records, though we have budgeted to collect a percentage of viral loads for youth who drop out of care or transfer to a care setting where records are not available.
Secondary Outcomes
- Change in Medication Adherence from Baseline to 9 months post intervention(Baseline, 4-, 7-, and 13-months)
- Change in Other Substance Use (not alcohol use) from Baseline to 9 months post intervention(Baseline, 4-, 7-, and 13-months)
- Change in Sexual Risk from Baseline to 9 months post intervention(Baseline, 4-, 7-, and 13-months)
Investigators
Sylvie Naar-King
Professor
Wayne State University