Alcohol misuse is a major driver of the HIV epidemic, impacting the spread and treatment of the virus both in the U.S. and globally. Misuse can increase the prevalence of the virus and diminish the health of those living with HIV, by increasing sexual risk behaviors, reducing adherence to antiretroviral therapy and increasing HIV-associated illnesses and mortality.
UNC’s ID Clinic is one of three U.S. sites participating in an implementation trial to test the facilitation of alcohol treatment in HIV care, through the NIAAA Alcohol Research Collaboration on HIV (ARCH) and CFAR Network of Integrated Clinical Systems (CNICS). The multi-site study also includes HIV clinics in Boston, MA, and San Diego, CA, through the CNICS. Geetanjali Chander, MD, from the University of Washington School of Medicine, is the ARCH study’s principal investigator.
ARCH Study
At UNC, Claire Farel, MD, is the study’s co-principal investigator. Farel says patients will be linked to the study through alcohol use screening, administered as part of routine HIV care visits or provider referral.
“People who are eligible will be offered the opportunity to participate in the study, to receive alcohol-related care and treatment, in conjunction with the clinic’s psychiatry and social work teams,” said Farel, medical director of the ID Clinic and co-director of the CFAR Clinical Core.
Sonia Napravnik, PhD, is principal investigator for the ARCH Chapel Hill study site, associate director of the CFAR Clinical Core and the UNC CNICS site principal investigator. She says the study is a critical next step for increasing access to evidence-based behavioral and pharmacologic interventions for unhealthy alcohol use in outpatient clinical care.
“In over a dozen years of work the efficacy of a stepped care model of alcohol treatment, including a brief intervention, cognitive behavior therapy, and alcohol pharmacotherapy, has been well demonstrated by our ARCH research group and others,” said Napravnik. “Yet, little is known about how to optimally implement these types of interventions in HIV clinical settings. This project is important to identifying successful approaches to implementing these interventions in care settings, and increasing access to much needed in-person and computer-delivered behavioral and pharmacological interventions.”
ARCH Investigator Support Team Visits Chapel Hill
In August, the UNC CFAR’s Clinical Core hosted the ARCH Investigator Support Team in Chapel Hill, to present a series of talks designed to kick off the study and prepare for the intervention study.
Chander opened the event by recognizing the intersection of unhealthy alcohol use and HIV care outcomes. Her recorded talk can be found here. Findings from prior interventions were also introduced by Emily Williams, PhD (UW Medicine), and D. Scott Batey, PhD (Tulane), who described measurement tools and implementation workflows, as well as the findings of pre-implementation qualitative interviews with clinic providers and staff. Visitors then toured the ID Clinic and learned about the intersection of UNC’s Ryan White Programs with key study outcomes, such as linkage to substance abuse treatment, medical case management and retention in care.
Amy Durr, MSN, FNP, associate director of the ID clinic and Ryan White Program Manager, sees the value of implementing routine and standardized alcohol assessments in the UNC HIV clinic, to identify patients at risk for negative health outcomes.
“This approach will facilitate a timely connection to effective multi-disciplinary treatment services within a trusted and supportive environment,” said Durr. “Additionally, heightened awareness will create opportunities for education on prevention.”
The UNC study team also includes Deana Agil, Lindsay Browne, and Aditi Chiney. Alexis Vien, MD, a new UNC internal medicine and addiction medicine specialist with a joint appointment in infectious diseases, will see patients in the ID Clinic.
ARCH was launched by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 2010, to study the impact of alcohol misuse on HIV prevention and the HIV care continuum.