IGHID 12219 - A Brief Alcohol Intervention for PrEP Use Among MSM in Vietnam: A Randomized Controlled Trial (BPrEP) (BPrEP)

IGHID 12219 - A Brief Alcohol Intervention for PrEP Use Among MSM in Vietnam: A Randomized Controlled Trial (BPrEP)

IGHID 12219 - A Brief Alcohol Reduction Intervention to Reduce Alcohol Use and Improve PrEP Outcomes Among Men Who Have Sex With Men: A Randomized Controlled Trial in Vietnam

National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (NIH), Hanoi Medical University, Ohio State University, Johns Hopkins University, University of Washington

The purpose of this study is to evaluate the effectiveness of a brief alcohol intervention (BAI) vs. standard of care (SOC) to improve pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) with unhealthy alcohol use initiating or re-initiating PrEP in Vietnam.

This is a two-arm effectiveness randomized controlled trial (RCT) to compare the brief alcohol intervention (BAI) to the standard of care (SOC) among MSM with unhealthy alcohol use who are initiating or reinitiating oral, event-driven, or injectable PrEP in Vietnam. The BAI draws from Motivational Interviewing (MI)/Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT) and includes 2 in-person sessions and 2 telephone sessions. Eligible participants (n=564) will be randomized 1:1 to each arm (282 per arm). Additional assessments among a subset of participants in the BAI arm will assess acceptability of the intervention (n=48) Study activities will span 5 years. Individual MSM participants will be followed-up for 12 months with assessment visits at 3, 6, 9, and 12 months after enrollment.

Preexposure Prophylaxis (PrEP), Alcohol Intervention, HIV/AIDS, Motivational Interviewing, Cognitive Behavioral Therapy, Motivational Enhancement Therapy, Vietnam, Cost Analysis, Economic Evaluation, Men who have sex with men

Participants receive the Brief Alcohol Intervention (2 in-person sessions and 2 phone sessions), study assessment visits, and standard of care from providers at the PrEP clinic.

The BAI draws from Motivational Interviewing (MI)/Motivational Enhancement Therapy (MET) and Cognitive Behavioral Therapy (CBT) and comprises 2 in-person face-to-face sessions and 2 booster telephone sessions by a trained counselor.

PrEP persistence is a measure of ongoing PrEP usage, defined as consistent presentation for care and refills.

The number of days with ≥5 standard drinks of alcohol per occasion among the previous 30 days as assessed on the Timeline Followback.

The incremental cost-effectiveness ratio (ICER) is expressed as the incremental cost of the Brief Alcohol Intervention (BAI) per quality adjusted life-year (QALY) gained. ICER is defined as [Ci - Ca]/[Ei - Ea] with Ci and Ca being the respective costs of the BAI [i] and assessment only [a], and Ei and Ea the corresponding effectiveness.

Acceptability is an implementation-focused outcome and will be assessed using the Mental Health Implementation Science Tools (mhIST) Acceptability Scale for consumers, which consists of 15 items containing responses on a 4-point Likert scale. The mhIST score is calculated as the mean score of all responses ranging from 1-4. Higher mhIST scores indicate higher acceptability.

Feasibility is an implementation-focused outcome and will be measured as the BAI completion rate among MSM. Three metrics will be considered, measured from the date of the first in-person session. The first metric will be the proportion of participants who completed all 4 sessions among those who were assigned to the intervention arm.

Feasibility is an implementation-focused outcome and will be measured as the BAI completion rate among MSM. Three metrics will be considered, measured from the date of the first in-person session. The second metric will be the proportion of participants who completed at least 2 sessions among those who were assigned to the intervention arm.

Feasibility is an implementation-focused outcome and will be measured as the BAI completion rate among MSM. Three metrics will be considered, measured from the date of the first in-person session. The third metric will be the proportion of participants who completed at least 4 sessions among those who initiated at least one session.

PrEP adherence is a measure of pill-taking behavior and will be assessed by self-report and pharmacy records. Adherence will be assessed per person based on the type of PrEP prescribed but will be compared as a single measure. Oral and event-driven PrEP adherence will be assessed as self-reported number of doses taken. Oral PrEP adherence is defined with two thresholds: ≥ 4 days/week, a threshold consistent with HIV prevention among MSM, and 7 days, indicating perfect adherence. Event-driven PrEP adherence will be defined as completion of the 2+1+1 regimen for every reported condomless anal intercourse event.

Risk-aligned PrEP use is a measure of whether PrEP use is consistent with concurrent risk behavior. It is defined as persistent oral/injectable PrEP, event-driven PrEP (2+1+1) with adherence, or clinician-supervised PrEP discontinuation for reduced sexual risk More specifically, risk-aligned PrEP is defined as: persistent oral or injectable PrEP, event-driven PrEP (2+1+1) with 100% adherence, or appropriate PrEP discontinuation for reduced sexual risk, using 1 of 2 definitions: clinician-approved PrEP discontinuation for reduced sexual risk, or PrEP self-discontinuation with documented minimal risk by Vietnamese guidelines and no concurrent sexually transmitted infection (STI).

Number of drinking days is defined as the number of days with any alcohol use, among the previous 30 days as assessed on the Timeline Followback. The timeline followback will be administered at enrollment, 3 months, 6 months, 9 months, and 12 months.

Drinks per drinking day is defined as the number of standard drinks of alcohol consumed on a drinking day, among the past 30 days as assessed on the Timeline Followback. The timeline followback will be administered at enrollment, 3 months, 6 months, 9 months, and 12 months.

Inclusion Criteria: Newly initiating PrEP or re-initiating PrEP after at least 3 months from a missed PrEP appointment, based on Vietnamese PrEP guidelines Assigned male sex at birth Identify as male Receptive or penetrative anal intercourse with a man in the past 6 months AUDIT-C score ≥ 4 (unhealthy alcohol use) 16 years of age or older Intention to receive PrEP care in Hanoi for 12 months Willingness to provide informed consent Exclusion Criteria: Psychological disturbance, cognitive impairment, or threatening behavior Unwilling to provide locator information Current participation in alcohol programs Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) ≥ 10, indicating risk for alcohol withdrawal

Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.