Rae Jean Proeschold-Bell1,2, Donna M Evon3, Jia Yao2, Donna Niedzwiecki4, Christina Makarushka2, Kelly A Keefe2, Ashwin A Patkar5,6, Paolo Mannelli5, James C Garbutt7,8, John B Wong9, Julius M Wilder10,11, Santanu K Datta12, Terra Hodge10, Susanna Naggie11,13,14, Michael W Fried3, Andrew J Muir10,11. 1. Duke Global Health Institute, Duke University, Durham, NC. 2. Duke Center for Health Policy & Inequalities Research, Duke University, Durham, NC. 3. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC. 4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. 5. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC. 6. Department of Community and Family Medicine, Duke University Medical Center, Duke University, Durham, NC. 7. Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina, Chapel Hill, NC. 8. Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC. 9. Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA. 10. Division of Gastroenterology, Department of Medicine, School of Medicine, Duke University, Durham, NC. 11. Duke Clinical Research Institute, Duke University, Durham, NC. 12. Department of Medicine, Duke University, Durham, NC. 13. Division of Infectious Diseases, School of Medicine, Duke University, Durham, NC. 14. Durham Veterans Affairs Medical Center, Durham, NC.
Abstract
BACKGROUND AND AIMS: Hepatitis C virus (HCV) and alcohol use are patient risk factors for accelerated fibrosis progression, yet few randomized controlled trials have tested clinic-based alcohol interventions. APPROACH AND RESULTS: A total of 181 patients with HCV and qualifying alcohol screener scores at three liver center settings were randomly assigned to the following: (1) medical provider-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT), including motivational interviewing counseling and referral out for alcohol treatment (SBIRT-only), or (2) SBIRT plus 6 months of integrated colocated alcohol therapy (SBIRT + Alcohol Treatment). The timeline followback method was used to assess alcohol use at baseline and 3, 6, and 12 months. Coprimary outcomes were alcohol abstinence at 6 months and heavy drinking days between 6 and 12 months. Secondary outcomes included grams of alcohol consumed per week at 6 months. Mean therapy hours across 6 months were 8.8 for SBIRT-only and 10.1 for SBIRT + Alcohol Treatment participants. The proportion of participants exhibiting full alcohol abstinence increased from baseline to 3, 6, and 12 months in both treatment arms, but no significant differences were found between arms (baseline to 6 months, 7.1% to 20.5% for SBIRT-only; 4.2% to 23.3% for SBIRT + Alcohol Treatment; P = 0.70). Proportions of participants with any heavy drinking days decreased in both groups at 6 months but did not significantly differ between the SBIRT-only (87.5% to 26.7%) and SBIRT + Alcohol Treatment (85.7% to 42.1%) arms (P = 0.30). Although both arms reduced average grams of alcohol consumed per week from baseline to 6 and 12 months, between-treatment effects were not significant. CONCLUSIONS: Patients with current or prior HCV infection will engage in alcohol treatment when encouraged by liver medical providers. Liver clinics should consider implementing provider-delivered SBIRT and tailored alcohol treatment referrals as part of the standard of care.
RCT Entities:
BACKGROUND AND AIMS: Hepatitis C virus (HCV) and alcohol use are patient risk factors for accelerated fibrosis progression, yet few randomized controlled trials have tested clinic-based alcohol interventions. APPROACH AND RESULTS: A total of 181 patients with HCV and qualifying alcohol screener scores at three liver center settings were randomly assigned to the following: (1) medical provider-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT), including motivational interviewing counseling and referral out for alcohol treatment (SBIRT-only), or (2) SBIRT plus 6 months of integrated colocated alcohol therapy (SBIRT + Alcohol Treatment). The timeline followback method was used to assess alcohol use at baseline and 3, 6, and 12 months. Coprimary outcomes were alcohol abstinence at 6 months and heavy drinking days between 6 and 12 months. Secondary outcomes included grams of alcohol consumed per week at 6 months. Mean therapy hours across 6 months were 8.8 for SBIRT-only and 10.1 for SBIRT + Alcohol Treatment participants. The proportion of participants exhibiting full alcohol abstinence increased from baseline to 3, 6, and 12 months in both treatment arms, but no significant differences were found between arms (baseline to 6 months, 7.1% to 20.5% for SBIRT-only; 4.2% to 23.3% for SBIRT + Alcohol Treatment; P = 0.70). Proportions of participants with any heavy drinking days decreased in both groups at 6 months but did not significantly differ between the SBIRT-only (87.5% to 26.7%) and SBIRT + Alcohol Treatment (85.7% to 42.1%) arms (P = 0.30). Although both arms reduced average grams of alcohol consumed per week from baseline to 6 and 12 months, between-treatment effects were not significant. CONCLUSIONS:Patients with current or prior HCV infection will engage in alcohol treatment when encouraged by liver medical providers. Liver clinics should consider implementing provider-delivered SBIRT and tailored alcohol treatment referrals as part of the standard of care.
Authors: Rae Jean Proeschold-Bell; Donna M Evon; Christina Makarushka; John B Wong; Santanu K Datta; Jia Yao; Ashwin A Patkar; Paolo Mannelli; Terra Hodge; Susanna Naggie; Julius M Wilder; Michael W Fried; Donna Niedzwiecki; Andrew J Muir Journal: Contemp Clin Trials Date: 2018-07-10 Impact factor: 2.226
Authors: Daniel Hargraves; Christopher White; Rachel Frederick; Margaret Cinibulk; Meriden Peters; Ashlee Young; Nancy Elder Journal: Public Health Rev Date: 2017-12-29
Authors: Deborah Konkle-Parker; Daniel Williams; Nicholas McAfee; Julie A Schumacher; Jefferson Parker Journal: J Behav Health Serv Res Date: 2022-08-10 Impact factor: 1.475
Authors: Michael D Stein; Debra S Herman; H Nina Kim; Abigail Howell; Audrey Lambert; Stephanie Madden; Ethan Moitra; Claire E Blevins; Bradley J Anderson; Lynn E Taylor; Megan M Pinkston Journal: AIDS Behav Date: 2020-10-12