Assessing the Feasibility and Acceptability of a Computer-based Avatar-delivered Alcohol Reduction Intervention

This study was terminated effective 3/23/2022

Significance of TB in India
In 2016 with over 2.1 million people living with HIV (PLWH) and 80,000 new infections, India ranked third globally in absolute HIV burden after South Africa (SA) and Nigeria. India also has the highest incidence of tuberculosis (TB) in the world, with 2.8 million new cases in 2016, including 89,000 new HIV+ cases. PLWH are nearly 30 times more likely to develop TB, and deaths from HIV-associated TB in India account for 2.8% of all TB deaths. Given these staggering statistics, optimizing the management of HIV and TB, in low and middle-income settings (LMIC) are high priorities for the US Office of AIDS Research, WHO and Indian Government. Alcohol misuse, encompassing heavy/hazardous use, binge drinking and alcohol use disorders (AUD), is rapidly increasing in India with more than 50% of drinkers meeting criteria for alcohol misuse. Alcohol is the most abused substance by PLWH and is associated with HIV transmission, decreased use of and adherence to ART, lower viral suppression, decreased engagement and retention in care, more rapid HIV disease progression and mortality. 

Proposal Rationale and Primary Research Question
Despite the availability of evidence-based alcohol treatment, multiple individual and structural barriers limit treatment access including alcohol-related stigma, underreporting of misuse, lack of treatment resources, and treatment costs. Computer-delivered screening and intervention address many of these barriers to alcohol treatment. They can increase identification of alcohol use and treatment, are low cost, scalable and can be integrated into diverse clinical settings, including HIV and TB clinics. Our team has developed an effective avatar-based computer-delivered intervention for alcohol reduction in HIV clinical settings tested in two US clinics. We now seek to adapt and test avatar-delivered alcohol treatment to TB/HIV clinics in India, with the goal of reducing alcohol use and improving clinical outcomes. The first steps in this process will involve both cultural tailoring of intervention content and the avatar, and understanding potential barriers to integration of this technology based treatment in Indian clinical settings.  Thus, using qualitative methods, we propose to examine the feasibility and acceptability of a computer-based avatar-delivered alcohol reduction intervention among an Indian population with HIV (PWH) and/or TB, and obtain feedback on how to culturally adapt this intervention.  We will also examine multi-level barriers and facilitators to integration of computer-delivered interventions for alcohol use in this setting.

Intended/Potential Use of Study Findings
Our evaluation will allow us to assess the feasibility and acceptability of a computer-based alcohol reduction intervention, and to adapt it culturally for an Indian setting.

Objectives

Assess the feasibility and acceptability of a computer-based avatar-delivered alcohol reduction intervention to:

• Evaluates the expert opinions of HIV TB care providers about potential barriers to a computer-based intervention in their setting
• Interview care providers to include their perspective on what would be needed to culturally-tailor a computer-based alcohol reduction intervention

Understand the patient perspective regarding a computer-based avatar for reducing alcohol use:

• Convene focus group discussions regarding a computer-based intervention and how to make it culturally relevant