Couples motivational interviewing and biological feedback to address unhealthy alcohol use and HIV prevention among sexual minority men

Unhealthy alcohol consumption is high among people at risk for HIV including those in relationships with main or primary partners. This impedes efforts to end the HIV epidemic in the US, and the range of effective interventions for couples is particularly limited. The proposed intervention components integrate attention to alcohol use and sexual HIV transmission risk reduction with a specific focus on enhancing uptake of biomedical HIV prevention in the form of pre-exposure prophylaxis (or PrEP). Comparable intervention work has only focused on individuals, neglecting relationship factors that impact health-behavior decision making. Relationship quality is associated with alcohol use and relationship-related concerns may impede uptake of HIV prevention. A comprehensive national strategy to address unhealthy alcohol use and HIV prevention must address the unique challenges faced by those in relationships. Building on our team’s successful interventions using couples motivational interviewing (CMI), we will develop and test an alcohol and HIV intervention for couples. We will incorporate novel forms of biological feedback on alcohol use as a standalone intervention and in combination with CMI to support relationship partners in the development and accomplishment of shared behavioral-health goals. For Aim 1, we will evaluate two biological feedback modalities: 1) a mobile breathalyzer with linked app to collect daily BAC levels; and 2) phosphatidylethanol (PEth; an alcohol biomarker) test results capturing drinking levels in the past 30-days. We will develop the biological feedback intervention using CMI principles, which will be theatre-tested with couples and the CALIBER CAB, and then refined. To allow couples to experience both modalities, 20 couples will use the breathalyzer technology for 30 days and will be given summarized BAC feedback, followed by PEth feedback. Feasibility and acceptability data will include breathalyzer completion rates, PEth testing rates, and satisfaction levels. Exit interviews with couples and our CAB will inform the final feedback intervention for the pilot trial phase. For Aim 2, we will synthesize and adapt materials from our prior interventions to develop the CMI intervention for unhealthy alcohol use and PrEP uptake. For Aim 3, we will recruit 100 couples (25 per arm) having an HIV-negative partner with a positive AUDIT-C screen and sexual risk indicators for PrEP. Couples will be randomly assigned to one of four arms: biological feedback only, CMI only, CMI with biological feedback, and enhanced usual care as the control arm. Couples will be assessed at baseline, 3-months, and 6-months. Feasibility and acceptability will be the primary focus, with exploratory analyses on outcomes including unhealthy alcohol use (AUDIT-C and/or PEth positive) and uptake of PrEP. The project is led by MPIs Conroy and Starks and it builds upon their established history of successful collaboration in couples-based research. It is supported by Dr. Hahn, an expert in biological indicators of alcohol use. The study draws upon the resources and scientific expertise of the larger CALIBER team to develop novel intervention applications of biological assessments of alcohol use.