Alcohol Research Consortium in HIV: Ending the HIV Epidemic through interventions and Epidemiology at the intersection of the alcohol and HIV care Continua

Established in 2011, the Alcohol Research Consortium in HIV (ARCH) conducts high impact epidemiological and intervention studies that address relationships between at-risk alcohol use and AUD, the HIV Care Continuum (HIV-CC) and health outcomes. ARCH is embedded in and has capitalized on the research and clinical infrastructure of the CFAR Network of Integrated Clinical Systems (CNICS), an eight site clinical cohort of university-based HIV clinics across the US, with many of these clinics located in high priority regions for Ending the HIV Epidemic (EHE). The overarching theme of the proposed P01 is to expand scientific knowledge and treatment interventions at the intersection of the Alcohol-Care Continuum (Alc-CC), HIV-CC and HIV related comorbidities across the full spectrum of alcohol use -- with particular attention to individual context and social determinants of health -- using implementation and epidemiological research. Our scientific goals are: 1) To implement evidence-based alcohol interventions (EBI) across the alcohol use spectrum among PWH using rigorous hybrid-implementation effectiveness designs; 2) To understand how multi-level contextual factors impact the alcohol use spectrum, the Alc-CC and HIV-CC, comorbidities, and intervention responses among PWH; 3) To determine optimal alcohol reduction targets (e.g. abstinence v low-risk drinking, reduction in WHO risk score) among PWH in the context of the Alc-CC, HIV-CC and HIV-related comorbidities. This ARCH P01 has three research projects. We are proposing a Hybrid Type III effectiveness-implementation trial integrating alcohol EBIs into HIV clinical care. This study is a direct extension of our earlier research findings demonstrating a robust effect of a computerized brief intervention embedded in a stepped care treatment approach for PWH with at-risk drinking. Our second project is a Hybrid Type1 effectiveness-implementation pilot trial developing and testing a novel relapse prevention intervention (RPI) for PWH. The importance of our focus on RPI is highlighted by our recent finding that any alcohol use among PWH with AUD is associated with increased viremia and the well-established high relapse prevalence of 50 – 75% of persons in remission. Our epidemiological project will provide outcomes data for the intervention trials as well as examine the full spectrum of alcohol use, the Alc-CC and their relationship to HIV-CC, comorbidities and co-infections in the context of social determinants of health. An administrative core provides the structure and processes to support collaboration and synergy across ARCH projects and investigators. A biostatistics and methods core supports analyses for the three projects and development of novel analytic methods. A transdisciplinary group of investigators brings depth and breadth of expertise to this program. Building on a decade of collaborative research progress and administrative structure in ARCH and capitalizing on the extensive resources of CNICS, this P01 proposal addresses issues of high relevance to the US goal of ending the HIV epidemic and the Office of AIDS Research priorities, including HIV Treatment as Prevention, HIV related comorbidities and disparities.