Project Summary/Abstract Alcohol consumption at hazardous levels is associated with negative consequences at nearly every step of the HIV care continuum. It is a critical factor in HIV treatment that significantly contributes to poor treatment-related outcomes. Randomized clinical trials (RCTs) of alcohol interventions for people with HIV (PWH) have had limited success, perhaps due to an increasingly recognized syndemic of co-occurring hazardous alcohol use and other mental health-related problems among PWH. Up to 63% of PWH meet criteria for both a substance use disorder and another psychiatric disorder—necessitating a shift in the literature towards transdiagnostic approaches that target core psychological processes that underlie multiple mental health and substance- related problems. One transdiagnostic mechanism that is particularly relevant to alcohol and other substance use is experiential avoidance (EA)— i.e., repeated, and maladaptive, use of substances and/or other behaviors to escape or avoid unwanted thoughts, feelings, and/or urges. Acceptance and commitment therapy (ACT) is a promising transdiagnostic intervention for PWH that targets EA. ACT is an empirically supported treatment for multiple psychological and behavioral health-related outcomes; however there have not been any full-scale RCTs of ACT for alcohol use among any population, including PWH. We recently adapted a telephone- delivered ACT intervention originally developed for smoking cessation, into an intervention for PWH who drink at hazardous levels (NIH/NIAAA; R34AA026246). With a multidisciplinary team, and with two rounds of input from PWH, we developed a six-session, telephone-delivered ACT intervention for alcohol use and subsequently conducted a pilot feasibility/acceptability RCT. We found high acceptability of the adapted ACT intervention, and evidence of feasibility for conducting a full-scale, remote, RCT. The overall objective of this application is therefore to determine the relative efficacy of ACT, compared to a standard Brief Alcohol Intervention (BI), for reducing alcohol use and comorbid symptoms of depression, anxiety, and stress among adult PWH who are hazardous drinkers. The specific aims are: To determine the relative efficacy of ACT, compared to BI, for reducing alcohol use among PWH (Aim 1) and to determine if ACT has an effect on transdiagnostic processes that in turn affect alcohol use and other psychological and functional outcomes (Aim 2). We will accomplish these aims by: conducting a fully remote, relative efficacy RCT in which we randomly assign 300 PWH who are hazardous drinkers to either the ACT intervention we developed (n = 150), or a BI intervention (n = 150) previously shown to reduce alcohol use among PWH. We will assess alcohol-related outcomes—via self-report and a biomarker (phosphatidylethanol) – at baseline, post-treatment, and again 3-, 6-, and 12-months post-randomization. We will also measure EA to determine if it mediates treatment effects for alcohol use and other psychological (i.e., symptoms of depression, anxiety, and stress) and functional outcomes, measured at all timepoints.

Project Narrative Alcohol is a significant problem in HIV care; novel intervention strategies are needed to decrease alcohol use and improve co-morbid psychological symptoms among people with HIV (PWH). The goal of this application is to conduct a remote, randomized clinical trial (RCT) of a brief, telephone-delivered Acceptance and Commitment Therapy (ACT) intervention to determine its efficacy relative to a standard brief alcohol intervention (BI). If successful, this intervention will have broad implications for implementation in HIV and other integrated care settings.