The majority of persons with HIV (PWH) in the US consume alcohol, despite the fact that alcohol use is associated with lower levels of HIV care engagement and HIV viral suppression. Over the past decade, our research team has established the Florida Cohort to support research and training with a mission to maximize HIV viral suppression and improve health outcomes in PWH. Key features of the Florida Cohort include a focus on alcohol-related issues, academic and community-based partnerships across the state, targeted enrollment of diverse populations, and linkage to statewide HIV surveillance data. The overarching goals of the current grant proposal are to advance understanding of the mechanisms influencing adherence to contemporary HIV therapeutic regimens, and to incorporate alcohol-related interventions into emerging clinic- and communitybased strategies to achieve and maintain HIV viral suppression across diverse populations. Mobile technologies such as smartphones and wrist-worn alcohol biosensors have emerged as new tools to investigate how unique patterns of drinking may be associated with different types of ART non-adherence (intentional, unintentional, systematic) in daily life. Wrist alcohol biosensors also have the potential to be incorporated into mHealth interventions in alcohol-using PWH to improve ART adherence and overall health
outcomes. Given the intertwined relationship between alcohol and other multilevel syndemic factors (e.g., individual, social/economic, health system), biosensor-based alcohol interventions might be most effective if integrated into existing programs that can simultaneously address other barriers to treatment success. The PositiveLinks (PL) app is a multimodal mHealth intervention for PWH including daily adherence assessment, appointment reminders, secure messaging with clinic providers, and an online anonymized peer support network. PL has been shown to be acceptable and to improve ART adherence and is now being implemented in the state of Virginia and several areas of Florida. However, the PL app does not currently address alcohol consumption. In this project, we propose to integrate a biosensor-based alcohol intervention into the PL app in a manner that could be implemented and sustained over time in various clinical and community settings. We propose to enroll and survey 1200 new Florida Cohort participants, with targeted enrollment for heavy drinkers and sexual/ethnic minorities. The survey data, with linkage to statewide HIV surveillance data, will allow us to identify multilevel factors contributing to ART adherence and viral suppression among alcohol-using PWH. From the overall cohort, 80 alcohol-using PWH will complete “enhanced monitoring (EM)” for one month. The EM group will wear a wrist alcohol biosensor, report alcohol and other risk factors (e.g., real-time anxiety, depression) and ART adherence through an ecological momentary assessment (EMA) app, and provide two dried blood spots (DBS) viral load tests. The EM data will help disentangle the temporal relationships between alcohol, other risk factors, and ART adherence in real-time. Survey and EM data together with input from the EM participants will be used to inform the adaptation of a biosensor-based mHealth intervention. Our interdisciplinary team will also meet regularly with a new Community/Provider Advisory Board (CAB), who will provide input related to the ongoing Florida Cohort (e.g., enrollment, survey design) and help to develop a plan to integrate the alcohol biosensor-based intervention into the PL app.