Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

Abstract

BackgroundAlcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH.MethodsA search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls.ResultsA total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out....

Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: a cluster randomized controlled trial

“…Across SSA where trained nurses provide HIV care, there are opportunities to capacitate these nurses to manage mental health comorbidities, such as problematic alcohol use [21,47]. Evidence-based interventions, such as MI-CBT for AUD, can be effectively delivered by up-skilling existing staff [20].…”

“…We have previously described the adaptation and preliminary testing of an intervention based on MI and simple CBT for AUD in an HIV care clinic in Zimbabwe [19,20]. Formative qualitative work identified stigma and the time commitment required by patients as being the main impediments to uptake [21].…”

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

“…Although many interventions have been developed to address drinking 19,20 and ART adherence 14,[16][17][18] among PLWH, many require substantial provider time or show limited efficacy. Given the well-documented relationship between heavy drinking and poor ART adherence [5][6][7][8] , our intervention addresses these two concerns together among alcohol dependent PLWH.…”

“…Several interventions to reduce unsafe drinking in PLWH have been developed 19,20 . However, few are brief, effective, and utilize technology to extend intervention.…”

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

“…Brief drinking-reduction interventions are effective at decreasing drinking in general primary care settings 15 , although alcohol dependent patients often require more extensive intervention 14,16,17 . Despite the importance of decreasing heavy drinking in PLWH, a growing literature of trials assessing alcohol interventions among PLWH shows that many interventions either lack efficacy or are very time-consuming 18,19 . Some HIV alcohol primary care interventions have been designed for easier dissemination, e.g., those based on the Screening and Brief Intervention with Referral to Treatment (SBIRT) model [20][21][22] and interventions utilizing technology 23,24 .…”