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Randomized Controlled Trial
. 2021 Feb;116(2):305-318.
doi: 10.1111/add.15112. Epub 2020 Jul 13.

A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya

Rebecca K Papas  1 , Benson N Gakinya  2 , Michael M Mwaniki  3 , Hana Lee  4 , Alfred K Keter  3 , Steve Martino  5 , Debra A Klein  6 , Tao Liu  4 , Michelle P Loxley  4 , John E Sidle  7 , Kathryn Schlaudt  8 , Tobista Nafula  3 , Victor M Omodi  3 , Joyce B Baliddawa  2 , Daniel W Kinyanjui  2 , Stephen A Maisto  9
Affiliations
Randomized Controlled Trial

A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya

Rebecca K Papas et al. Addiction. 2021 Feb.

Abstract

Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub-Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive-behavioral therapy (CBT) intervention to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya.

Design: Randomized clinical trial.

Setting: A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration.

Participants: A total of 614 HIV-infected outpatients [312 CBT; 302 healthy life-styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking.

Intervention and comparator: A culturally adapted six-session gender-stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90-minute sessions with a 9-month follow-up.

Measurements: Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time-line follow-back from baseline to 9 months post-intervention. Exploratory analyses examined unprotected sex and number of partners.

Findings: Median attendance was six sessions across condition. Retention at 9 months post-intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD - CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 - 4.04; DDD - CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 - 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1-month follow-up.

Conclusions: A cognitive-behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV-infected Kenyan outpatient drinkers.

Keywords: Alcohol; HIV; Kenya; cognitive-behavioral therapy; paraprofessional; randomized clinical trial.

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Conflict of interest statement

We have no conflicts of interest to report

Figures

Figure 1.
Figure 1.
CONSORT diagram of eligibility, enrollment, randomization, intervention, and follow-up rates. CBT=cognitive behavioral therapy; HL=Healthy Lifestyles education *Unrelated deaths are excluded from calculation of retention rate
Figure 2.
Figure 2.
Observed means of percent drinking days and mixed effect model fit across three study phases: active intervention (baseline to week 6), follow-up (weeks 7 to 30), and maintenance periods (weeks 31 to 46). CBT=Cognitive-Behavioral therapy HL=Healthy Lifestyles education. Note: baseline represents previous 30 days
Figure 3.
Figure 3.
Observed means of drinks per drinking day and mixed effect model fit across three study phases: active intervention (baseline to week 6), follow-up (weeks 7 to 30), and maintenance periods (weeks 31 to 46) CBT=Cognitive-Behavioral therapy HL=Healthy Lifestyles education. Note: baseline represents previous 30 days
See this image and copyright information in PMC

References

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