Healthcare Provider Perceptions on Screening and Treatment for Unhealthy Alcohol Use in HIV Primary Care Settings

Unhealthy alcohol use (UAU) and alcohol use disorder (AUD) disproportionately burden people with HIV (PWH). We aimed to understand barriers and facilitators to the screening and treatment of UAU/AUD through semi-structured interviews with 19 healthcare providers in three HIV clinics. Interviews were coded using a rapid assessment process. Barriers included: (1) mixed use and variable perceived benefit of alcohol screening tools, (2) heterogeneity in perceived benefit of and comfort with AUD pharmacotherapy, (3) perception of alcohol as a lower priority than other substance use disorders and (4) compassion fatigue. Facilitators included: (1) co-located AUD care within HIV clinics (2) clinical champions with experience in alcohol treatment, and (3) Telemedicine as a potential strategy to better engage patients with UAU/AUD. Primary care teams face challenges in screening and offering pharmacotherapy to PWH. Interventions should address beliefs regarding treatment and improve screening for UAU/AUD in HIV care settings.