Measuring Intraday Alcohol Use and Mood Among Individuals with HIV

Background: Improving engagement in the HIV care continuum is imperative to enhance health outcomes and reduce HIV transmission rates. Alcohol use has been shown to interrupt medication adherence and incite poor health outcomes. Until recently, the gold standard of reporting alcohol use has been recall. This study used Ecological Momentary Assessment (EMA) to monitor intraday alcohol use to better identify detrimental patterns of alcohol use. This study was a pilot study to examine alcohol use patterns among individuals with HIV and determine mood patterns that are associated with use.

Methods: Eligible participants were recruited from an outpatient HIV clinic (>21 years of age, HIV diagnosis, and recent reports of alcohol use). Ecological Momentary Assessment (EMA) data were collected using a smartphone app among 15 participants for 28 days each. Each time a participant consumed alcohol, they reported use and mood (as measured by the PANAS) in the app.  Descriptive and correlation statistics were conducted to assess patterns of alcohol use.

Results: Overall, the majority of the participants were African American (n=14), male (n=13), and had a mean age of 37.0 (SD=8.8). The average number of days that drinking occurred in the study was 4.83 (SD=3.51). 36% of the days were on the weekend, 64% were during the week. 87% of the days had one drinking episode, while 13% of the days had two episodes. Number of drinking episodes was not related to weekend versus weekday (p-value=.765).  The average number of drinks per episode was 4.28 (SD= 5.24), with a median of 3 drinks (1 to 29 drinks). 37% of the respondents reported drinking hard liquor exclusively, while 36% and 20% reported wine and beer respectively. The remaining 7% drank a mixture. During time periods where drinking was reported, the average PANAS negative score was 1.18 (SD=0.34). PANAS positive average was 2.87 (SD=1.01).  The average impulse score was 1.31 (SD=0.69). Number of alcohol drinks was positively correlated with PANAS negative mean (p<  0.05).Higher number of alcohol drinks was related to weekend days as compared to weekdays. Number of alcohol drinks was positively related to PANAS Negative mood, but not to PANAS Positive mood or to Impulse.

Conclusions: EMA provides intraday measures of alcohol and mood. These initial findings of patterns of alcohol use reveal an image of use that has potential to highlight more detrimental patterns. Using EMA will allow future studies to identify detrimental patters of alcohol use and how they affect engagement and adherence to HIV care.