4 - (SYM 94) Acceptance and Commitment Therapy for People with HIV and Unhealthy Alcohol Use: Development and Execution of a Remote Randomized Clinical Trial

Unhealthy alcohol use among people with HIV (PWH) is prevalent and is associated with significant HIV and other health-related consequences. The high prevalence of unhealthy alcohol use among PWH occurs alongside a high prevalence of other psychiatric problems – with up to 63% of PWH reporting meeting criteria for both a substance use and another psychiatric disorder. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment that targets experiential avoidance as an underlying factor common to mental and behavioral health problems. Mindfulness skills and values-guided behavioral action plans are used to decrease experiential avoidance and impact a broad array of psychological symptoms via improved psychological acceptance. We recently adapted and pilot tested a brief (6-session), telephone-delivered ACT intervention for PWH who drink at unhealthy levels. We first conducted formative work with PWH and HIV care providers in order to tailor the ACT intervention, and then conducted a pilot feasibility/acceptability RCT designed to inform a full-scale efficacy trial, which was recently funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01AA030935; PI: Woolf-King). Here we report on the procedures we pilot tested and are currently implementing for the remote RCT—including remote collection of biospecimens for objective measurement of alcohol use and stress, telephone-based administration of intervention content, HIPAA-compliant Zoom interviewer-administered surveys and study visits, and procedures for training, supervision, and fidelity monitoring of study interventionists. As we have done in our intervention development work to-date, our goal in sharing these procedures is to increase transparency, reproducibility, and quality of remote RCTs designed to test the efficacy of behavioral and psychological interventions that can be feasibly implemented in medical settings.