HealthCall: Smartphone Enhancement of Brief Interventions to Reduce Heavy Drinking In HIV Care

Abstract

BackgroundHeavy drinking among people living with HIV (PLWH) worsens their health outcomes and disrupts their continuum of care. Brief interventions to reduce heavy drinking in primary care are effective, but in heavy-drinking PLWH, more extensive intervention may be needed. 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, in order to reduce drinking and improve other aspects of HIV care while making minimal demands on providers.MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinician’s Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline drinking-reduction interventions were ∼25 minutes, with brief (10-15 min) check-in sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking and other aspects of the prior 24 hours. Outcomes assessed at 30 and 60 days, and 3, 6 and 12 months, included drinks per drinking day, drinks per day, and days drank, using the Timeline Followback. Analysis were conducted using generalized linear mixed models with pre-planned contrasts.ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. During treatment, patients in MI+HealthCall drank less than others (p=0.07-0.003). However, at 6 and 12 months, drinking was lowest among patients who had been in CG+HealthCall (p=0.04-0.06).ConclusionDuring treatment, patients in MI+HealthCall drank less than patients in the CG conditions. However, at 6 and 12 months, drinking was lower among patients in CG+HealthCall. Given the importance of drinking reduction and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

HealthCall: Smartphone Enhancement of Brief Interventions to Improve Medication Adherence Among Patients in HIV care

“…In sum, this research provides evidence that the HealthCall administered via smartphone can extend the reach of brief intervention in decreasing drinking 21 and increasing medication adherence among alcohol-dependent PLWH, providing a valuable tool that can enhance several aspects of health together among alcohol dependent PLWH. Technology has become increasingly useful and well-recognized in managing health.…”

“…As described elsewhere 21 , of the 114 enrolled patients, 58% were male, 75% were African American, 28% were Hispanic, and 62% had less than a high school education. The mean age was 47.5 years (SD = 10 years) and the mean number of years of HIV infection was 18.6 (SD =7.6).…”

“…Potentially eligible patients were informed about the study by IRB approved flyers in the clinic waiting room and/or by their providers, who referred them to meet with a study coordinator for written informed consent and assessment of eligibility. Of 180 individuals screened in-person with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV (PRISM-IV-Computerized Version) 23 , 114 met eligibility, completed baseline assessments, and were randomized (see Hasin et al, 2020 MedRxiv for further detail on study enrollment) 21 . In a parallel three-arm 1:1:1 randomized design, participants were assigned to one of three conditions: CG-only (n=37), CG +HealthCall (n=38), or MI+HealthCall (n=39).…”

“…If the participant was not available/home at the time of the initial call, the interviewer called again at additional times. For the purpose of the current study, we used 30-day, 60-day, 3 month, 6 month, and 12 month data, to parallel the timeframes analyzed in our primary drinking analysis 21 .…”

“…Therefore, utilizing the visual and video features of smartphone technology, we developed and tested “HealthCall,” an electronic (smartphone) intervention designed to enhance the efficacy of brief interventions (e.g., Motivational Interviewing (MI) and the NIAAA Clinician’s Guide [CG]) to reduce drinking and improve ART adherence among PLWH without making unfeasible demands on providers. We have already shown that HealthCall is an effective adjunct to these brief interventions in reducing heavy drinking 21 . However, the efficacy of HealthCall to improve ART medication adherence among heavy drinkers has not yet been assessed.…”