Barriers and Facilitators in Implementing “Prevention for Positives” Alcohol-Reduction Support: The Perspectives of Directors and Providers in Hospital-Based HIV Care Centers

Strauß, Simon; Munoz-Plaza, Corrine; Tiburcio, Nelson J.; Gwadz, Marya

doi:10.1016/j.jana.2011.03.001

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…This finding is supported by prior qualitative reviews of alcohol screening in clinic settings, which highlight the barriers to enhancing screening of patient alcohol use; trials on the efficacy of brief interventions for alcohol risk reduction are notable exceptions to this trend. 45, 48 HIV providers in our sample perceived a lack of patient receptivity and low readiness to change their alcohol behaviors. By contrast, among alcohol providers, their ambivalence may reflect a sense that HIV-associated interventions are beyond the scope of their care and not necessarily pertinent to their work.…”

Section: Discussionmentioning

confidence: 86%

“…47 The challenges in performing an effective assessment of alcohol use are compounded by the lack of time available in most clinical encounters to address these challenging issues. 48 In a study of HIV providers in New York, it was found that having a fixed case load, increased duration of time in practice, exposure to information on HIV and alcohol use, and perceived self-efficacy were important determinants for use alcohol interventions in practice. 49 There have been no studies addressing the role or the challenges of addressing HIV care in the context of alcohol treatment.…”

Section: Introductionmentioning

confidence: 99%

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Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

Montague

Kahler

Colby

et al. 2015

Addictive Disorders &Amp; Their Treatment

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Objectives Unhealthy alcohol use is common among HIV-infected patients and contributes to co-morbidities, cognitive decline, unprotected sex, and poor medication adherence. Studies consistently show missed opportunities to address unhealthy alcohol use as part of care. Although treatment of other drug use has been integrated into HIV care in some settings, more information is needed regarding provider attitudes regarding the need for integration of alcohol treatment and HIV care. Methods We surveyed 119 HIV and 159 addiction providers regarding the following domains: existing knowledge, desire for new knowledge (with subdomains relative advantage, compatibility, and complexity of integrating knowledge), and individual and program development needs. Scale scores for each domain were correlated with demographics to identify factors associated with training need. Results Both HIV and addiction providers reported agreement with statements of existing knowledge and the need for additional skills. The priority attributed to training, however, was low for both groups. Knowledge and perceived prevalence of HIV and unhealthy alcohol use increased with years of experience. Perceived prevalence correlated with compatibility but not the relative advantage of training. Conclusions Though addressing alcohol use and HIV was acknowledged to be important, the priority of this was low, particularly early career providers. These providers may be important targets for training focusing on motivating coordination of care and skills related to assessment and counseling.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

Montague

Kahler

Colby

et al. 2015

Addictive Disorders &Amp; Their Treatment

View full text Add to dashboard Cite

show abstract

“…However, the successful treatments took 6–15 sessions (9–22.5 hours) to achieve their results. Limited staff time and resources in HIV primary care clinics generally preclude such treatment within the clinic (Metsch et al, 2008; Strauss and Mino, 2011; Strauss et al, 2012, 2009) and patients seldom follow referrals from medical settings to outside alcohol treatment (Miller et al, 2006; Saitz, 2010). Thus, if briefer drinking-reduction interventions within the HIV medical setting were effective, they could provide an important means of helping HIV patients who drink heavily.…”

Section: Introductionmentioning

confidence: 99%

Commitment strength, alcohol dependence and HealthCall participation: Effects on drinking reduction in HIV patients

Aharonovich¹,

Stohl²,

Ellis³

et al. 2014

Drug and Alcohol Dependence

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BACKGROUND The role of three factors in drinking outcome after brief intervention among heavily drinking HIV patients were investigated: strength of commitment to change drinking, alcohol dependence, and treatment type: brief Motivational Interview (MI) only, or MI plus HealthCall, a technological extension of brief intervention. METHODS HIV primary care patients (N=139) who drank ≥4 drinks at least once in the 30 days before study entry participated in MI-only or MI+HealthCall in a randomized trial to reduce drinking. Patients were 95.0% minority; 23.0% female; 46.8% alcohol dependent; mean age 46.3. Outcome at end of treatment (60 days) was drinks per drinking day (Timeline Follow-Back). Commitment strength (CS) was rated from MI session recordings. RESULTS Overall, stronger CS predicted end-of-treatment drinking (p<.001). After finding an interaction of treatment, CS and alcohol dependence (p=.01), we examined treatment × CS interactions in alcohol dependent and non-dependent patients. In alcohol dependent patients, the treatment × commitment strength interaction was significant (p=.006); patients with low commitment strength had better outcomes in MI+HealthCall than in MI-only (lower mean drinks per drinking day; 3.5 and 4.6 drinks, respectively). In non-dependent patients, neither treatment nor CS predicted outcome. CONCLUSIONS Among alcohol dependent HIV patients, HealthCall was most beneficial in drinking reduction when MI ended with low commitment strength. HealthCall may not merely extend MI effects, but add effects of its own that compensate for low commitment strength. Thus, HealthCall may also be effective when paired with briefer interventions requiring less skill, training and supervision than MI. Replication is warranted.

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“…Not all providers educate drinkers about these risks (Strauss et al, 2009), consistent with findings of poor quality of HIV patient-provider communication among heavy drinkers compared to other groups of HIV patients (Korthuis et al, 2011). Educational discussions may not have occurred due to provider reservations about alcohol intervention (Strauss et al, 2009, Strauss et al, 2012), or patient under-reporting of drinking. Alternately, information may have been provided to the patients, but not understood or believed.…”

Section: Discussionmentioning

confidence: 99%

“…When providers do discuss drinking, their recommendations are variable, with some providers recommending abstention and others citing health benefits of moderate drinking (Shacham et al, 2011). Similar to other primary care settings, providers in HIV settings underutilize brief, effective drinking interventions due to skepticism regarding their efficacy, low concern about patients’ drinking, and time limitations (Strauss et al, 2012, Strauss et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Perceived Medical Risks of Drinking, Alcohol Consumption, and Hepatitis C Status Among Heavily Drinking HIV Primary Care Patients

Elliott

Aharonovich

O’Leary

et al. 2014

Alcoholism Clin & Exp Res

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BACKGROUND Heavy drinking poses significant risks to the health and survival of individuals infected with HIV, particularly those co-infected with hepatitis C virus (HCV). However, little is known about patients’ perceptions of these risks, and whether these perceptions relate to their alcohol consumption. METHODS A sample of 254 heavily drinking HIV primary care patients (78% male; 94.5% minority; 31.8% with HCV) reported on their perceptions of the medical risks of drinking and on their alcohol consumption prior to participation in a drinking-reduction intervention trial. RESULTS In the HIV-infected sample as a whole, 62.9% reported that they had a medical problem made worse by drinking, and 64.3% reported restricting drinking to avoid future medical problems. Although patients co-infected with HIV/HCV reported greater efforts to restrict drinking to avoid future medical problems (AOR=1.94), their reported drinking quantity and frequency did not differ from that of HIV mono-infected patients. Awareness of medical risk was not associated with drinking level. Effort to restrict drinking to avoid medical risk was associated with lower drinking quantity, frequency, and binge frequency (ps<0.05), but the association with binge frequency was specific to patients without HCV. CONCLUSIONS Over one-third of HIV patients are unaware of the medical risks of drinking, and do not restrict use, suggesting the need for intervention in this group. Patients co-infected with HIV/HCV may report more effort to restrict drinking, but their reported drinking quantity and frequency suggest that they are actually drinking just as heavily as HIV mono-infected patients. Awareness of medical risk was unrelated to drinking, which suggests the need for interventions consisting of more than simple education. However, reported effort to restrict drinking did predict less drinking, suggesting the importance of patient commitment and initiative in change.

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Barriers and Facilitators in Implementing “Prevention for Positives” Alcohol-Reduction Support: The Perspectives of Directors and Providers in Hospital-Based HIV Care Centers

Cited by 15 publications

References 21 publications

Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

Commitment strength, alcohol dependence and HealthCall participation: Effects on drinking reduction in HIV patients

Perceived Medical Risks of Drinking, Alcohol Consumption, and Hepatitis C Status Among Heavily Drinking HIV Primary Care Patients

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