Abstract The COVID-19 pandemic has had a significant impact on the mental health and alcohol use of the United States (US) general population, and has disproportionately affected people living with HIV (PLWH). Alcohol consumption and stress are both critical factors in HIV treatment that, if unaddressed, can significantly contribute to onward transmission and poor treatment-related outcomes. Alcohol interventions for PLWH in the US have shown mixed results. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co-morbid mental health conditions, stress, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed, especially in the context of the COVID-19 pandemic. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, and is thus a promising approach for PLWH who are hazardous drinkers and coping with additional stress related to the COVID-19 pandemic. We are proposing to expand our ongoing, NIAAA- funded (R34AA026246), pilot RCT of a telephone-delivered ACT intervention for PLWH by applying for an administrative supplement in response to the Notice of Special Interest on Stress Management in Relation to COVID-19 (NOT-AT-20-011). The overall objective of this application is to use the infrastructure of our ongoing pilot RCT (NCT0397406) to collect preliminary data on the level of stress experienced by PLWH during the COVID-19 pandemic, and to determine if participants in the RCT find the stress management techniques in our ACT intervention useful and applicable for the management of COVID-related stress. The specific aims are as follows: Aim 1: Incorporate objective and self-reported measures of stress into the pilot RCT. We will accomplish this aim by: adding general and pandemic-specific self-report measures of stress, and self- collected samples of salivary cortisol to all study visits, including a newly added 12-month follow-up. Aim 2: Determine the feasibility and acceptability of ACT as a telephone-based stress management intervention for PLWH during the COVID-19 pandemic. We will accomplish this aim by modifying our treatment manuals to incorporate COVID-19 related stress, and examining stress-related RCT outcomes by treatment condition. This administrative supplement will provide important information on COVID-related stress among PLWH, and provide data on the feasibility and potential efficacy of telephone-delivered ACT for stress management.

Project Narrative The COVID-19 pandemic has had a significant impact on the mental health and alcohol use of the United States general population, and has disproportionately affected people living with HIV (PLWH). Novel intervention strategies are needed in order to decrease alcohol use and stress among this population, and improve HIV treatment-related outcomes. The goal of this application is to expand our ongoing, NIAAA-funded (R34AA026246), pilot RCT of a telephone-delivered ACT intervention for PLWH to address stress associated with the COVID-19 pandemic.