A Personalized Digital Intervention to Reduce Alcohol Use and Improve HIV Care Outcomes

About This Grant

ABSTRACT Hazardous alcohol use among people with HIV occurs at nearly twice the rate of the general population and contributes to poor antiretroviral therapy adherence, reduced retention in care, neurocognitive complications, and increased mortality. These health risks are amplified by co-occurring negative affect symptoms (e.g., anxiety, depression), which are highly prevalent among people with HIV and associated with more severe alcohol use and functional impairment. Despite the syndemic nature of these challenges, scalable, mechanism-focused interventions that simultaneously target hazardous drinking and negative affect within HIV care are lacking. One promising strategy is to target transdiagnostic mechanisms that drive hazardous drinking and negative affect. Anxiety sensitivity, the fear of anxiety-related sensations, is one such mechanism contributing to anxiety, depression, and hazardous drinking, and is elevated among people with HIV. Anxiety sensitivity is modifiable, and reducing anxiety sensitivity improves drinking severity, emotional functioning, and related health outcomes. Our team has developed brief, computer-delivered personalized feedback interventions (PFIs) targeting anxiety sensitivity and hazardous drinking, demonstrating reductions in both anxiety sensitivity and alcohol use in at-risk populations. In parallel, we developed a PFI specifically for hazardous drinking among people with HIV, which was feasible, acceptable, and revealed promising findings. We have integrated these components to create a unified, scalable digital intervention (I-PFI) designed for people with HIV. I-PFI is a single-session (20–30 minute), computer-delivered intervention providing personalized feedback on hazardous alcohol use, negative affect, and HIV-related health, combined with interactive psychoeducation and evidence-based strategies (e.g., interoceptive exposure, physical activity). Aim 1 will refine I-PFI and evaluate it among 20 adult people with HIV with hazardous drinking and elevated negative affect, using mixed methods to assess acceptability, clarity, and perceived relevance. Aim 2 will conduct an RCT comparing I-PFI to 1) an active alcohol-only PFI and 2) a content-matched nutrition control PFI among 300 adult people with HIV with hazardous drinking and elevated negative affect from two HIV clinics. Participants will complete twice-daily ecological momentary assessments for 30 days post- intervention and follow-up assessments at 1, 3, and 6 months post-intervention. Primary outcomes include hazardous drinking (phosphatidylethanol biomarker), alcohol consumption, and alcohol-related consequences; secondary outcomes include HIV-related outcomes (high-risk sexual behavior, antiretroviral therapy adherence, quality of life) and reductions in anxiety sensitivity, anxiety, and depression. This project directly addresses PAS-25- 208 by advancing a scalable, mechanism-focused behavioral intervention integrated within HIV care settings, targeting alcohol use and mental health to improve HIV outcomes.