Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial
Karnik N, Kuhns L, Hotton A, Del Vecchio N, McNulty M, Schneider J, Donenberg G, Keglovitz Baker K, Diskin R, Muldoon A, Rivera J, Summersett Williams F, Garofalo R. Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial. JMIR Ment Health 2023;10:e43653. DOI: 10.2196/43653
This study tested the efficacy of a fully automated electronic screening and brief intervention, Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults in community-based HIV testing environments in Chicago. Effects on sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention were also examined. Three hundred twenty-nine participants aged 16-25 years who identified as a man or transgender woman who has sex with men and reported moderate to high alcohol use were randomly assigned to a brief single-visit intervention or attention control condition (modules of similar length on promotion of diet and nutrition). The Step Up, Test Up intervention used a motivational interviewing approach to deliver lessons on 11 topics focused on alcohol use. Data were collected at 1, 3, 6, and 12-months post intervention. There were no significant group differences in alcohol use outcomes over time. There was a significant but small reduction in condomless anal sex under the influence of alcohol and drugs at 12 months compared to 3 months among participants in the intervention group relative to the control group (incidence rate ratio=0.15, 95% CI 0.05-0.44). There were no significant group differences in sexual risk and PrEP engagement. The relative lack of effect of the intervention on alcohol misuse and associated risks may reflect a need for cultural tailoring and more dynamic and engaging components in the intervention.