Among people living with HIV and alcohol use disorder, integrated stepped alcohol treatment (ISAT) did not reduce the number of weekly drinks any more than the usual alcohol treatment method, according to a study of 128 people attending U.S. Veterans Affairs HIV clinics that was published in The Lancet. However, ISAT did appear to yield several benefits over treatment as usual, suggesting promise for the method, study authors suggested.
Participants were randomized to ISAT (63 people) or treatment as usual (65) for 24 weeks. Both arms then continued on standard treatment through week 52. At that point, 34 people were left in the original ISAT group] and 52 in the control group. About half of ISAT participants received alcohol treatment medications, which could be prescribed during addiction physician management in Step 1. If drinking targets were not met after four weeks, four sessions of motivational enhancement therapy were added in Step 2. A third of participants attended two or more of these sessions. After 12 weeks, those who still exceeded drinking targets were referred to specialist services in Step 3. Meanwhile, "treatment as usual" included only brief counseling and referral to specialists.
Although the number of drinks consumed by ISAT recipients each week was no lower than people receiving treatment as usual at 24 and 52 weeks, ISAT recipients did show a number of improvements, including fewer heavy drinking days, fewer drinks on days when alcohol consumption occurred, and greater likelihood of having an undetectable viral load.
Study authors called for promoting ISAT while enhancing patient engagement and retention in the program.