Unhealthy Alcohol Use Clinical Trial
— FIRSTOfficial title:
Financial Incentives, Randomization With Stepped Treatment Trial
Verified date | March 2024 |
Source | Yale University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The investigators plan to determine the effectiveness of contingency management (CM) plus stepped care for unhealthy alcohol use in HIV-positive patients.
Status | Completed |
Enrollment | 120 |
Est. completion date | April 1, 2023 |
Est. primary completion date | April 1, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Be HIV-infected. - Recent significant alcohol consumption as determined by a PEth greater than 20 ng/ml. - Able to provide informed consent. - Meet any of the following criteria for unhealthy alcohol use: - At-risk Drinking - greater than 14 drinks per week or greater than 4 drinks per occasion in men and greater than 7 drinks per week or greater than 3 drinks per occasion in women and those over 65.161 - Medical condition impacted by alcohol as evidenced by one of the following: 1) detectable HIV viral load (>200 copies/ml),) tobacco use disorder and smoking more than 5 cigarettes per day, 3) detectable HCV virus, 4) liver fibrosis with a FIB-4 >1.45) Patient Health Questionnaire (PHQ-9, validated measure for depression) score greater than 9, or 6) current (at least 30 day supply in the past 60 days) prescription for a psychoactive medication that interacts with alcohol-including benzodiazepines, opioids, antipsychotics, antidepressants, sleeping medications and muscle relaxants. - Alcohol Use Disorder - Meet DSM-5 criteria for alcohol use disorder, not in remission Exclusion Criteria: No subject may: - Be acutely suicidal, or with a psychiatric condition that affects his/her ability to provide informed consent or participate in counseling interventions (e.g. psychotic, dementia, delusional). - Be currently enrolled in formal treatment for alcohol (excluding mutual-help, e.g. Alcoholics Anonymous) - Have medical conditions that would preclude completing or be of harm during the course of the study. - Be a pregnant or nursing woman or women who do not agree to use a reliable form of birth control. - Have a current diagnosis of or be in remission for a gambling disorder given the gaming nature of CM. |
Country | Name | City | State |
---|---|---|---|
United States | VA Medical Center | Atlanta | Georgia |
United States | James J. Peters VA Medical Center | Bronx | New York |
United States | VAMC Houston | Houston | Texas |
United States | Greater Los Angeles VA Healthcare Center Infectious Disease Section | Los Angeles | California |
United States | Louisiana Health Sciences Center | New Orleans | Louisiana |
United States | VA NY Harbor Healthcare System | New York | New York |
United States | Washington DC Veterans Affairs | Washington | District of Columbia |
Lead Sponsor | Collaborator |
---|---|
Yale University | National Institute on Alcohol Abuse and Alcoholism (NIAAA), VA Connecticut Healthcare System |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Undetectable HIV Viral Load | Viral load will be analyzed as a continuous measure (log10 copies/ml). | 6 months | |
Other | Smoking Cessation by Exhaled Carbon Monoxide | It is measured by CO monitor | 6 months | |
Other | Liver Fibrosis Based on Fibrosis-4 (FIB-4) Score | The Fibrosis-4 score helps to estimate the amount of scarring in the liver. Using a lower cutoff value of 1.45, a FIB-4 score <1.45 had a negative predictive value of 90% for advanced fibrosis (Ishak fibrosis score 4-6 which includes early bridging fibrosis to cirrhosis). In contrast, a FIB-4 >3.25 would have a 97% specificity and a positive predictive value of 65% for advanced fibrosis. In the patient cohort in which this formula was first validated, at least 70% patients had values <1.45 or >3.25. | 6 months | |
Other | Undetectable Hepatitis C Viral Load | An HCV antibody test is used to screen for past exposure and current infection. It detects the presence of antibodies to the virus, indicating exposure to HCV. | 6 months | |
Other | Depressive Symptoms Via PHQ-9 | Patient Health Questionnaire (PHQ-9) ranges from 0 to 27. A higher score indicates worse depression. 5-9 are minimal symptoms, 10-14 is considered minor depression, 15-19 is major depression that is moderately severe, and >20 is severe, major depression. | 6 months | |
Other | Recent Receipt of a Psychoactive Medication That May Interact With Alcohol | number of patients with use of psychoactive medications that interact with alcohol | 6 months | |
Primary | Self-reported Abstinence From Alcohol | Recorded via web based time-line followback | 6 months | |
Secondary | Proportion of Participants of Participants With Phosphatidylethanol (PeTH) Documented Abstinence by the Alcohol Biomarker, Phosphatidylethanol (PEth) | Phosphatidylethanol (PEth) accumulates in human red blood cells when the body is exposed to ethanol. Alcohol biomarkers are physiological indicators of alcohol exposure or ingestion and may reflect the presence of chronic and/or high level of use of alcohol. This will be evaluated as a binary variable to determine the proportion with abstinence (defined as % with PEth value <8ng/mL). | 6 month | |
Secondary | Change in Biological Markers as Measured by the VACS Index | The Veterans Aging Cohort Study Index (VACS Index) creates a score by summing pre-assigned points for age, routinely monitored indicators of HIV disease (CD4 count and HIV-1 RNA), and general indicators of organ system injury including hemoglobin, platelets, aspartate and alanine transaminase (AST and ALT), creatinine, and viral hepatitis C infection (HCV). This score is weighted to indicate increasing risk of all-cause mortality with increasing score. The score can be used to estimate risk of all-cause mortality using a conversion factor. The VACS Index will be evaluated based on most recent values at the time of data extraction. VACS Index score will be treated as a continuous variable. Possible scores range from 0 to 164. A higher score indicates greater burden of disease. | 6 months |
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