In an effort to improve antiretroviral therapy adherence (ART) and health outcomes, HealthCall seeks to reduce alcohol and non-injection drug use in HIV patients.
HealthCall combines motivational interviewing, personalized feedback, and self-monitoring to decrease substance use. Patients attend one brief motivational interviewing session with a counselor and set a goal for reduction of substance use. After this first session, the automated HealthCall system calls patients daily for 60 days. During each 1-3 minute phone call, patients are asked to report on substance use, mood, and health-related behaviors. Patients are given personalized graphs summarizing substance use at monthly booster motivational interviewing sessions with a counselor.
In 2017, researchers developed HealthCall-s, a mobile application version of HealthCall. HealthCall-s includes a video counselor who guides participants through responding to self-monitoring questions, providing reinforcement for participants’ responses to self-monitoring questions, and offering tips for maintaining abstinence that participants can save for later reference.
Motivational Interviewing (MI)
Non-injection drug use
Reduce substance use
Young Adults (18-30)
Outpatient HIV clinic
Summary: The authors conducted a before-and-after study of HealthCall in a primary care clinic among HIV patients who engaged in risky alcohol use. All 30 participants were given a motivational interviewing (MI) session with a counselor at the clinic, and had access to the HealthCall system. Participants returned for MI booster sessions monthly. Alcohol use was measured at baseline, 30 days, and 60 days. Adherence to the HealthCall intervention was excellent. During the initial 30 days, participants completed 80% of the HealthCall daily phone calls. Call adherence was highest in participants who used cocaine, spoke Spanish, had a home or cell phone, and felt sick at baseline. Participants had positive reactions to the calls and reported that the program increased their awareness of their drinking. Although no statistically significant changes were seen at the 30 day follow-up, significant decreases in drinking were seen at 60 days. Participants initially drank an average of 3.2 drinks per day, which dropped to an average of 1.2 drinks per day at 60 days.
Take Away: The HealthCall intervention is associated with decreased drinking in HIV-positive individuals.
HealthCall: Technology-based extension of Motivational Interviewing to reduce non-injection drug use in HIV primary care patients: A pilot study.
Summary: In this randomized pilot trial of HealthCall for non-injection drug use (NIDU), 40 HIV-positive patients at an outpatient clinic were selected to participate. All participants had used non-injection drugs for at least four days in the month prior to enrollment. While 20 participants were randomized to a motivational interviewing (MI) session plus HealthCall, the 20 participants assigned to the control group only received the initial MI session. Substance use outcomes were measured at baseline, 30 days, and 60 days. Results showed that HealthCall was a feasible intervention. Overall, 57% of participants assigned to HealthCall wanted to continue the intervention after 60 days. From baseline to 60 days, monthly substance use decreased significantly in both the HealthCall and control groups. Monthly days of substance use dropped from an average of 10.2 days to 4.1 days in the control group. The HealthCall group decreased their average substance use from 9.2 to 2.0 days per month. As anticipated by the small sample size, no significant differences in days of drug use were detected between groups.
Take Away: HealthCall is a feasible and acceptable intervention for non-injection drug users with HIV. Further research is needed to determine its effectiveness on decreasing NIDU.
Reducing heavy drinking in HIV primary care: A randomized trial of brief intervention, with and without technological enhancement.
Summary: A randomized controlled trial of HealthCall for risky drinking was conducted. Patients with HIV (n=254) attending several urban primary care clinics were randomly assigned to either an educational control, motivational interviewing (MI) only, or MI plus HealthCall. All participants had engaged in risky drinking during the month prior to the study. Participants assigned to the educational control viewed a 30-minute video on HIV self-care and received a pamphlet on drinking reduction. Similar to the Aharonovich (2006) pilot trial, participants in the MI only group met with a counselor for a MI session at baseline. Participants in the MI+HealthCall group completed the MI session, in addition to daily automated calls monitoring drinking and health behaviors. Alcohol use was assessed at baseline, 30 days, and 60 days. Results showed that 48% of patients met criteria for past year alcohol dependence. At the 60 day follow-up, participants getting either MI only or MI+HealthCall had greater reductions in drinking than the educational control. Among participants with alcohol dependence, receiving MI+HealthCall lead to the largest reductions in alcohol use. Alcohol dependent participants getting MI only or the education control had significantly smaller reductions in drinking. Participants without alcohol dependence had equal decreases in drinking across all three conditions.
Take Away: For HIV-positive patients with alcohol dependence, combining HealthCall and MI is more effective in reducing drinking than MI alone, or one educational session.
Drinking motive as prospective predictors of outcome in an intervention trial with heavily drinking HIV patients.
Summary: This secondary analysis of the Hasin (2013) randomized controlled trial examined how drinking motives impact drinking outcomes and alcohol dependence after treatment. Patients with heavy alcohol use and HIV either received an alcohol education session, a motivational interviewing (MI) session, or MI plus the HealthCall program. Drinking motives, alcohol use, and alcohol dependence diagnoses were measured at baseline, 30 days, and 60 days. Participants who used alcohol to cope with negative emotions at baseline were more likely to continue heavy drinking and meet criteria for alcohol dependence at the 60 day follow-up. Other drinking motives (e.g., drinking due to peer pressure, drinking to facilitate social interactions) were not associated with alcohol use or alcohol dependence after treatment. These findings were consistent across treatment condition.
Take Away: After completing alcohol treatment, HIV-positive patients who drink to cope with negative affect are at higher risk for continued heavy alcohol use.
Commitment strength, alcohol dependence, and HealthCall participation: Effects on drinking reduction in HIV patients.
Summary: To look at the effects of commitment strength on drinking outcomes, the authors conducted a secondary analysis of the Hasin (2013) randomized controlled trial of HealthCall. Patients with HIV and heavy alcohol use were enrolled and randomized to an educational control, motivational interviewing (MI) only, or MI plus HealthCall. Participants in the educational control group were excluded from this analysis. To assess commitment strength, the authors reviewed tapes of the initial MI session from the remaining 166 participants. Participants were dichotomized as either having high or low commitment strength based on change talk from the session. Results revealed that commitment strength at the end of the MI session predicted alcohol use outcomes. A one unit increase in commitment strength was associated with a 28% decrease in drinking at 60 days. For alcohol dependent patients with low commitment strength, being enrolled in MI+HealthCall lead to better drinking outcomes at 60 days than receiving MI alone. Alcohol use outcomes at 60 days were comparable regardless of treatment assignment in participants with no alcohol dependence, or high commitment strength.
Take Away: For HIV patients with alcohol dependence and low commitment strength, participation in HealthCall plus MI leads to better drinking outcomes than MI alone.
Reducing non-injection drug use in HIV primary care: A randomized trial of brief motivational interviewing, with and without HealthCall, a technology-based enhancement.
Summary: Researchers used clinician referral to recruit 240 patients at an HIV clinic reporting substance use. Participants were randomized to receive a motivational interviewing (MI) intervention, MI augmented by HealthCall, or an HIV self-care educational DVD without substance use-related content. MI involved an initial 25-30 session including MI techniques and goal setting for substance use reduction in the next 30 days and 2 booster sessions 30 and 60 days later. Participants completed interviews assessing past 30-day substance use using timeline follow back at baseline, 60 days (treatment-end), and 6 and 12 months. Self-reported substance use was confirmed using urine screens. Researchers estimated cost of use in the past 30 days for each participant’s primary substance of use. Treatment retention at 6 and 12 months did not significantly differ between treatment groups. Participants in all treatment groups reduced days of primary substance use and cost of primary substance use between baseline and 60 days. Reductions were maintained for MI and MI with HealthCall groups at 6 and 12 months. MI participants reported significantly greater reductions than control in cost of primary substance use at 6 and 12 months and greater reductions in days of primary substance use at 12 months than at 6 months. When analyzing only participants with drug dependence (n=39), MI participants reported significantly fewer days of use and spending less on primary substance of use at 6 months than MI with HealthCall participants, though these differences were not maintained at 12 months.
Take away: HealthCall as an adjunct to MI was not superior to MI alone for improving substance use in patients at an HIV clinic.
HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized controlled trial.
Summary: Researchers recruited 47 people with HIV reporting non-injection drug use or binge drinking (at least 6 days in the past 30 days) using newspaper advertisements and pamphlets in HIV clinics and health programs. Participants were randomized to receive a motivational interviewing (MI) intervention targeting substance use or MI augmented by HealthCall adapted for smartphones (HealthCall-s). HealthCall-s participants received a study smartphone with HealthCall-s installed. Participants reported past 30-day substance use using timeline follow back at baseline and 30 and 60 days (treatment-end). Self-reported substance use was confirmed using urine screens (non-injection drug use) and breathalyzers (alcohol use). Feasibility was assessed using number of days using HealthCall-s out of total possible days of use, treatment completion, and participant ratings of treatment satisfaction. HealthCall-s participants completed an assessment of treatment engagement at treatment end. Researchers analyzed treatment effects on number of days of self-identified primary substance use, money spent on primary substance use (estimated from timeline follow back reports), number of drinking days, and number of drinks per day. Both groups reported reductions in all four outcome measures between baseline and 60 days. Participants in the HealthCall-s group experienced significantly greater reductions in days of primary substance use (50% fewer) and cost of primary substance use (33% less) than the MI group. There were no group differences in reductions in alcohol use. HealthCall-s participants rated their intervention satisfaction 4.5/5 on average. Median rate of HealthCall-s use was 95% of possible days and 95% of participants completed treatment across both groups.
Take Away: HealthCall-s with MI was superior to MI alone for reducing non-injection drug use in people with HIV.