Given multiple pathways through which alcohol impacts HIV morbidity, mortality and transmission, the Brown University ARCH provides an integrated, multifaceted, interdisciplinary approach to forward science on alcohol/HIV interactions and inform clinical approaches to caring for people living with HIV and efforts to prevent HIV transmission.
The ARCH has 6 integrated parts: an Administrative Core, three Research Components, and two Scientific Cores (Virology and Biostatistics). In addition, there is a Resource Cores (U24) funded by NIAAA that conducts work on mechanisms of behavior change in alcohol-HIV interventions.
Research Component 1 (Alcohol and HIV-Associated Brain Dysfunction) The proposed study will investigate effects of ETOH consumption on HIV-associated brain dysfunction, incorporating state-of-the-art brain imaging methods along with clinical and laboratory methods to assess the interactive effects of ETOH consumption on HIV-associated brain dysfunction. There are two broad objectives. The first is to continue an ongoing line of research, extending current findings by incorporating functional neuroimaging (FMRI) approaches, along with additional magnetic resonance spectroscopy (MRS) methods that will enable us to delineate both functional and cerebral metabolic disturbances affecting specific functional brain systems that are associated with the interaction of ETOH and HIV, as well as alterations in functional connectivity within and between these systems. The second objective is to examine the extent to which reductions in ETOH consumption among heavy drinkers with HIV infection that result from a motivational intervention lead to improvements in these functional and metabolic neuroimaging measures, as well as neurocognitive performance.
Research Component 2 (Behavioral Interventions to Reduce Heavy Drinking in HIV-Infected Men in Primary Care) is a fully-crossed 2 X 2 X 2 factorial randomized controlled trial with a diverse sample of 224 MSM recruited from 2 urban HIV primary care clinics (one in the Northeast and one in the South). The first study factor will compare brief advice (BA) vs. a motivation intervention (MI) that contains detailed personalized normative and HIV-specific feedback. The second factor compares an interactive text messaging (ITM) intervention vs. no text messaging. The final factor compares intervention of low intensity and duration (two sessions over 1 month) to extended intervention (EI) entailing 5 sessions over 9 months. BA and MI will be delivered by a core set of interventionists from a central location using a webcam-enabled telemedicine system, which can facilitate larger-scale implementation. The design will allow us to test the hypothesis that MI compared to BA, ITM compared to no ITM, and EI compared to no EI, will result in significantly greater reductions in number of alcoholic drinks consumed and number of heavy drinking days at 6- and 12-month follow-ups.
Research Component 3 (Mechanisms of Acute alcohol Effects on High Risk Behaviors in HIV-Vulnerable Men ). Among men who have sex with men (MSM) in the US, annual rates of new HIV infections continue to grow, despite stability or decline among other at-risk groups. This trend is due in part to unprotected sexual behavior that poses high per-act transmission risk. Alcohol increases the risk for HIV infection among MSM, likely due to alcohol’s association with increased unprotected sexual behavior. Past studies suggest that alcohol intoxication specifically co-occurs with increased odds of engaging in sexual behavior that poses high transmission risk. However, the mechanisms by which alcohol intoxication leads to increases in sex risk among MSM are poorly understood, and experimental research on alcohol’s on sexual decision-making among MSM has been limited to date. This project examines the effects of alcohol intoxication on sexual decision-making and behavior among MSM using a video-based sexual scenario task. We employ a between-subjects experimental design with 3 conditions (true control, placebo, and alcohol [0.08%]). The long-term goal of this research is to advance theoretical understanding of the alcohol-risky sex link, and to use this knowledge to guide a future line of research focused on developing and testing new approaches to intervention for MSM.