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Article
HealthCall: A randomized trial assessing a smartphone enhancement of brief interventions to reduce heavy drinking in HIV care
Journal of Substance Abuse Treatment (2022)
  • Deborah S Hasin, PhD
  • Efrat Aharonovich, Columbia University
  • Barry S Zingman, Montefiore Medical Center and Albert Einstein College of Medicine
  • Malka Stohl, New York State Psychiatric Insitute
  • Claire Walsh, New York State Psychiatric Institute
  • Jennifer C Elliott, Molloy College
  • David S Fink, New York State Psychiatric Institute
  • Justin Knox, New York State Psychiatric Institute
  • Sean Durant, Montefiore Medical Center and Albert Einstein College of Medicine
  • Raquel Menchaca, Montefiore Medical Center and Albert Einstein College of Medicine
  • Anjali Sharma, Montefiore Medical Center and Albert Einstein College of Medicine
Abstract
Introduction
Heavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their HIV care. Although brief interventions to reduce heavy drinking in primary care are effective, more extensive intervention may be needed in PLWH with moderate-to-severe alcohol use disorder. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed the “HealthCall” app to provide continued engagement after brief intervention, reduce drinking, and improve other aspects of HIV care with minimal demands on providers. We conducted a randomized trial of its efficacy.

Methods
The study recruited alcohol-dependent PLWH (n = 114) from a large urban HIV clinic. Using a 1:1:1 randomized design, the study assigned patients to: Motivational Interviewing (MI) plus HealthCall (n = 39); NIAAA Clinician's Guide (CG) plus HealthCall (n = 38); or CG-only (n = 37). Baseline MI and CG interventions took ~25 min, with brief (10–15 min) 30- and 60-day booster sessions. HealthCall involved daily use of the smartphone app (3–5 min/day) to report drinking and health in the prior 24 h. Outcomes assessed at 30 and 60 days and at 3, 6 and 12 months included drinks per drinking day (DpDD; primary outcome) and number of drinking days, analyzed with generalized linear mixed models and pre-planned contrasts.

Results
Study retention was excellent (85%–94% across timepoints). At 30 days, DpDD among patients in MI + HealthCall, CG + HealthCall, and CG-only was 3.80, 5.28, and 5.67, respectively; patients in MI + HealthCall drank less than CG-only and CG + HealthCall (IRRs = 0.62, 95% CI = 0.46, 0.84, and 0.64, 95% CI = 0.48, 0.87, respectively). At 6 months (end-of-treatment), DpDD was lower in CG + HealthCall (DpDD = 4.88) than MI + HealthCall (DpDD = 5.88) or CG-only (DpDD = 6.91), although these differences were not significant. At 12 months, DpDD was 5.73, 5.31, and 6.79 in MI + HealthCall, CG + HealthCall, and CG-only, respectively; DpDD was significantly lower in CG + HealthCall than CG-only (IRR = 0.71, 95% CI = 0.51, 0.98).

Conclusions
During treatment, patients in MI + HealthCall had lower DpDD than patients in other conditions; however, at 12 months, drinking was lowest among patients in CG + HealthCall. Given the importance of drinking reduction and the low costs/time required for HealthCall, pairing HealthCall with brief interventions merits widespread consideration.
Keywords
  • alcohol dependence,
  • HIV,
  • brief behavioral intervention,
  • smartphone,
  • technological intervention,
  • motivational interviewing
Disciplines
Publication Date
2022
DOI
10.1016/j.jsat.2022.108733
Citation Information
Deborah S Hasin, Efrat Aharonovich, Barry S Zingman, Malka Stohl, et al.. "HealthCall: A randomized trial assessing a smartphone enhancement of brief interventions to reduce heavy drinking in HIV care" Journal of Substance Abuse Treatment (2022)
Available at: http://works.bepress.com/jennifer-elliott/44/