Project ART-ED: alcohol reduction and HIV testing in the emergency department

Abstract

BACKGROUND: Unhealthy alcohol use is associated with sexual risk behaviors and subsequent HIV risk. Preventive care, including alcohol brief interventions and HIV testing, are becoming more normative in the Emergency Department (ED) setting to reach young unhealthy drinkers as this is often their primary source of medical care. Notably, interventions targeting this population in the ED to promote HIV prevention are lacking. Our goal in this pilot study was to determine the feasibility and impact of providing a brief alcohol and sexual risk reduction counseling session with rapid HIV testing in the ED. METHODS: We recruited patients, ages 18 to 40 years, from a large urban ED; meeting NIAAA criteria for at-risk drinking; with at least 1 sexual risk behavior; with negative or unknown HIV status and willing to undergo testing. Our intervention combined a brief alcohol and sexual risk reduction counseling session with rapid HIV testing. We conducted a 2-week booster call. The counseling intervention was manual-guided, modeled after Brief Negotiation Interview and Project RESPECT-2 and designed to be delivered in less than 15 minutes. Assessments included the Timeline Follow-Back to quantify alcohol consumption and modified HIV Risk Behavior Scale to characterize sexual risk behaviors at baseline and 8 weeks. Statistical analyses included Wilcoxon Signed Rank test, McNemar test, and two-way ANOVA.We recruited patients, ages 18 to 40 years, from a large urban ED; meeting NIAAA criteria for at-risk drinking; with at least 1 sexual risk behavior; with negative or unknown HIV status and willing to undergo testing. Our intervention combined a brief alcohol and sexual risk reduction counseling session with rapid HIV testing. We conducted a 2-week booster call. The counseling intervention was manual-guided, modeled after Brief Negotiation Interview and Project RESPECT-2 and designed to be delivered in less than 15 minutes. Assessments included the Timeline Follow-Back to quantify alcohol consumption and modified HIV Risk Behavior Scale to characterize sexual risk behaviors at baseline and 8 weeks. Statistical analyses included Wilcoxon Signed Rank test, McNemar test, and two-way ANOVA. RESULTS: Of the 65 enrolled, 66% are male, mean age is 24 years, 61% white, 82% unmarried, 55% college-educated, 42% without primary care, and 80% with AUDIT score > 8. All tested HIV negative. Among the 49 with follow-up to date, alcohol consumption decreased with fewer average weekly drinks (23.7 vs. 8.8, p This decrease was significantly associated with gender (p Post-intervention, participants endorsed increased condom use (median change=3 points on a 5-point scale, W=105, pOf the 65 enrolled, 66%aremale,mean age is 24 years, 61% white, 82%unmarried, 55% college-educated, 42% without primary care, and 80% with AUDIT score > 8. All tested HIV negative. Among the 49 with follow-up to date, alcohol consumption decreased with fewer average weekly drinks (23.7 vs. 8.8, p<0.001). Post-intervention, participants endorsed increased condom use (median change=3 points on a 5-point scale, W=105, p<0.0001). CONCLUSION: In this pilot study, a brief intervention combining alcohol and sexual risk reduction counseling with rapid HIV testing is feasible and effective in the ED for reducing alcohol use and HIV risk behaviors among young unhealthy drinkers. By focusing on this population in this setting, we are providing a tailored intervention that impacts both alcohol consumption and sexual risk behaviors for a group of vulnerable patients that may not otherwise be reached for routine preventive medical care.In this pilot study, a brief intervention combining alcohol and sexual risk reduction counseling with rapid HIV testing is feasible and effective in the ED for reducing alcohol use and HIV risk behaviors among young unhealthy drinkers. By focusing on this population in this setting, we are providing a tailored intervention that impacts both alcohol consumption and sexual risk behaviors for a group of vulnerable patients that may not otherwise be reached for routine preventive medical care.