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The Cost-Effectiveness of Adapting and Implementing a Brief Intervention to Target Frequent Alcohol Use Among Persons with HIV in Vietnam

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Abstract

Brief interventions to reduce frequent alcohol use among persons with HIV (PWH) are evidence-based, but resource-constrained settings must contend with competition for health resources. We evaluated the cost-effectiveness of two intervention arms compared to the standard of care (SOC) in a three-arm randomized control trial targeting frequent alcohol use in PWH through increasing the percent days abstinent from alcohol and viral suppression. We estimated incremental cost per quality-adjusted life year (QALY) gained from a modified societal perspective and a 1-year time horizon using a Markov model of health outcomes. The two-session brief intervention (BI), relative to the six-session combined intervention (CoI), was more effective and less costly; the estimated incremental cost-effectiveness of the BI relative to the SOC, was $525 per QALY gained. The BI may be cost-effective for the HIV treatment setting; the health utility gained from viral suppression requires further exploration.

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Abbreviations

ART:

Antiretroviral therapy

AUDIT-C:

Alcohol Use Disorders Inventory Test

BI:

Brief intervention

CBT:

Cognitive behavioral therapy

CoI:

Combined intervention

HIV:

Human immunodeficiency virus

MI:

Motivational interviewing

PWH:

Persons with HIV

RCT:

Randomized control trial

SOC:

Standard of care

VS:

Viral suppression

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Acknowledgements

We would like to acknowledge those who agreed to participate in the study and the staff at UNC Project Vietnam for their collaboration in designing and conducting this study.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (NIH) under Award Number R01DA037440. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This publication resulted (in part) from research supported by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR), an NIH-funded program P30 AI050410.

Author information

Authors and Affiliations

  1. Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, CB #7420, Chapel Hill, NC, 27599-7420, USA

    Natalie A. Blackburn, Vivian F. Go, Teerada Sripaipan, Shelley Golden, Carol Golin & Nisha Gottfredson

  2. University of North Carolina Project Vietnam, Hanoi, Vietnam

    Quynh Bui & Tran Viet Ha

  3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Heidi Hutton

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Radhika P. Tampi & David W. Dowdy

  5. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Carl A. Latkin

  6. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Geetanjali Chander

  7. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Constantine Frangakis

Authors
  1. Natalie A. Blackburn
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  2. Vivian F. Go
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  3. Quynh Bui
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  4. Heidi Hutton
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  5. Radhika P. Tampi
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  6. Teerada Sripaipan
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  7. Tran Viet Ha
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  8. Carl A. Latkin
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  9. Shelley Golden
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  10. Carol Golin
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  11. Geetanjali Chander
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  12. Constantine Frangakis
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  13. Nisha Gottfredson
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  14. David W. Dowdy
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Contributions

NB: conception, design, data collection, data analysis, and writing manuscript. VG: Conception, design, data collection, data analysis, and manuscript reviewing. QB, RPT, TS: data collection, data analysis, and manuscript reviewing. TVH, HH, CL, and CF: conception, design, data interpretation, and manuscript reviewing. SG, CG, and NG: data interpretation and manuscript reviewing. DD: conception, design, data collection, data analysis, and manuscript reviewing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Natalie A. Blackburn.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

Ethical approval for this study was obtained from the Institutional Review Board at the University of North Carolina as well as the Institutional Review Board at the Thai Nguyen Center for Preventive Medicine.

Consent to Participate

Written informed consent was provided by all participants in the study.

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All authors have provided consent for publication.

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Appendices

Appendix 1. Details of REDART Intervention Content

 

In-person sessions

Other sessions

Strategies

Content

Standard of care

0 Sessions

None

Referral

No interaction between HIV provider and alcohol treatment provider

Brief intervention

2 Sessions

2 Phone booster sessions

Cognitive behavioral

Didactic training on skills including: Problem solving, coping skills, and drinking refusal

Motivational enhancement

Combined intervention

6 Sessions

3 Group sessions

Cognitive behavioral

Role playing emphasized, participant-led for training on skills including: Problem solving, coping skills, and drinking refusal

Motivational enhancement

Appendix 2. 1000 Person Cohort of the Drinking and Viral Suppression Status When Comparing the Three Trial Arms

 

Drinking status

HIV viral suppression

Time pointa

Frequent

Semi-frequent

Abstinent

Suppressed

Not suppressed

SOC

BI

CoI

SOC

BI

CoI

SOC

BI

CoI

SOC

BI

CoI

SOC

BI

CoI

Baseline

547

547

547

438

438

438

15

15

15

840

840

840

160

160

160

Month 1

547

547

547

438

438

438

15

15

15

840

840

840

160

160

160

Month 2

547

547

547

438

438

438

15

15

15

840

840

840

160

160

160

Month 3

542

276

320

421

575

625

37

149

52

871

866

822

129

134

178

Month 4

534

182

235

430

664

676

36

154

86

881

877

815

119

123

185

Month 5

530

154

201

434

680

689

36

165

106

884

882

812

116

118

188

Month 6

478

225

224

483

655

626

38

120

148

839

872

865

161

128

135

Month 7

473

269

238

488

633

589

38

97

172

842

870

878

158

130

122

Month 8

471

295

246

491

618

568

38

86

186

843

869

880

157

131

120

Month 9

442

311

251

518

609

555

40

80

194

828

869

881

172

131

119

Month 10

439

320

254

521

604

548

40

77

198

829

868

881

171

132

119

Month 11

438

325

255

522

600

544

40

75

201

830

868

881

170

132

119

1 Year

456

280

256

491

624

636

53

96

108

763

911

834

237

89

166

Total person-months

5897

3737

3574

5676

7138

6945

427

1126

1481

10,091

10,432

10,229

1909

1568

1771

Total person-years

491

311

298

473

595

579

36

94

123

841

869

852

159

131

148

  1. Definitions: Frequent—at last a drink every day in the past 30 days; semi-frequent—fewer than 4 drinks a week in the past 30 days; abstinent—no drinks in the past 30 days; BI—brief intervention; SOC—standard of care; CoI—combined intervention
  2. aTransitions for months 7–12 are based on trial data collected at 6 and 12 months post-intervention

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Blackburn, N.A., Go, V.F., Bui, Q. et al. The Cost-Effectiveness of Adapting and Implementing a Brief Intervention to Target Frequent Alcohol Use Among Persons with HIV in Vietnam. AIDS Behav 25, 2108–2119 (2021). https://doi.org/10.1007/s10461-020-03139-y

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