Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial
Abstract Introduction Unhealthy alcohol use significantly contributes to viral non‐suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub‐Saharan Africa (SSA). Met...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-12-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26187 |
| _version_ | 1797375108814209024 |
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| author | Sarah B. Puryear Florence Mwangwa Fred Opel Gabriel Chamie Laura B. Balzer Jane Kabami James Ayieko Asiphas Owaraganise Elijah Kakande George Agengo Elizabeth Bukusi Stella Kabageni Daniel Omoding Melanie Bacon John Schrom Sarah Woolf‐King Maya L. Petersen Diane V. Havlir Moses Kamya Judith A. Hahn |
| author_facet | Sarah B. Puryear Florence Mwangwa Fred Opel Gabriel Chamie Laura B. Balzer Jane Kabami James Ayieko Asiphas Owaraganise Elijah Kakande George Agengo Elizabeth Bukusi Stella Kabageni Daniel Omoding Melanie Bacon John Schrom Sarah Woolf‐King Maya L. Petersen Diane V. Havlir Moses Kamya Judith A. Hahn |
| author_sort | Sarah B. Puryear |
| collection | DOAJ |
| description | Abstract Introduction Unhealthy alcohol use significantly contributes to viral non‐suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub‐Saharan Africa (SSA). Methods As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills‐based alcohol intervention among PWH with self‐reported unhealthy alcohol use (Alcohol Use Disorders Identification Test–Consumption [AUDIT‐C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non‐suppression, defined as either recent HIV viral non‐suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3‐month in‐person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT‐C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks. Results Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol‐serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93–1.1). Among PWH with baseline viral non‐suppression, 24‐week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93–1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79–0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56–0.88) than men (RR 0.93, 95% CI: 0.85–1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53–0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92–1.02). Conclusions In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non‐suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV‐associated co‐morbidities. |
| first_indexed | 2024-03-08T19:17:27Z |
| format | Article |
| id | doaj.art-5ddc06080c9f4b30834fad0939024351 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-08T19:17:27Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-5ddc06080c9f4b30834fad09390243512023-12-27T05:20:28ZengWileyJournal of the International AIDS Society1758-26522023-12-012612n/an/a10.1002/jia2.26187Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trialSarah B. Puryear0Florence Mwangwa1Fred Opel2Gabriel Chamie3Laura B. Balzer4Jane Kabami5James Ayieko6Asiphas Owaraganise7Elijah Kakande8George Agengo9Elizabeth Bukusi10Stella Kabageni11Daniel Omoding12Melanie Bacon13John Schrom14Sarah Woolf‐King15Maya L. Petersen16Diane V. Havlir17Moses Kamya18Judith A. Hahn19Division of HIV, ID and Global Medicine University of California San Francisco California USAInfectious Diseases Research Collaboration Mbarara UgandaKenya Medical Research Institute Kisumu KenyaDivision of HIV, ID and Global Medicine University of California San Francisco California USADivision of Biostatistics School of Public Health University of California Berkeley Berkeley California USAInfectious Diseases Research Collaboration Mbarara UgandaKenya Medical Research Institute Kisumu KenyaInfectious Diseases Research Collaboration Mbarara UgandaInfectious Diseases Research Collaboration Mbarara UgandaKenya Medical Research Institute Kisumu KenyaKenya Medical Research Institute Kisumu KenyaInfectious Diseases Research Collaboration Mbarara UgandaInfectious Diseases Research Collaboration Mbarara UgandaNational Institute of Allergy and Infectious Diseases Bethesda Maryland USADivision of HIV, ID and Global Medicine University of California San Francisco California USADepartment of Psychology Syracuse University Syracuse New York USADivision of Biostatistics School of Public Health University of California Berkeley Berkeley California USADivision of HIV, ID and Global Medicine University of California San Francisco California USADepartment of Medicine Makerere University College of Health Sciences Kampala UgandaDivision of HIV, ID and Global Medicine University of California San Francisco California USAAbstract Introduction Unhealthy alcohol use significantly contributes to viral non‐suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub‐Saharan Africa (SSA). Methods As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills‐based alcohol intervention among PWH with self‐reported unhealthy alcohol use (Alcohol Use Disorders Identification Test–Consumption [AUDIT‐C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non‐suppression, defined as either recent HIV viral non‐suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3‐month in‐person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT‐C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks. Results Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol‐serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93–1.1). Among PWH with baseline viral non‐suppression, 24‐week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93–1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79–0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56–0.88) than men (RR 0.93, 95% CI: 0.85–1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53–0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92–1.02). Conclusions In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non‐suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV‐associated co‐morbidities.https://doi.org/10.1002/jia2.26187HIVviral suppressionalcohol usebrief counselling interventionsub‐Saharan Africarandomized controlled trial |
| spellingShingle | Sarah B. Puryear Florence Mwangwa Fred Opel Gabriel Chamie Laura B. Balzer Jane Kabami James Ayieko Asiphas Owaraganise Elijah Kakande George Agengo Elizabeth Bukusi Stella Kabageni Daniel Omoding Melanie Bacon John Schrom Sarah Woolf‐King Maya L. Petersen Diane V. Havlir Moses Kamya Judith A. Hahn Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial Journal of the International AIDS Society HIV viral suppression alcohol use brief counselling intervention sub‐Saharan Africa randomized controlled trial |
| title | Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial |
| title_full | Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial |
| title_fullStr | Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial |
| title_full_unstemmed | Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial |
| title_short | Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial |
| title_sort | effect of a brief alcohol counselling intervention on hiv viral suppression and alcohol use among persons with hiv and unhealthy alcohol use in uganda and kenya a randomized controlled trial |
| topic | HIV viral suppression alcohol use brief counselling intervention sub‐Saharan Africa randomized controlled trial |
| url | https://doi.org/10.1002/jia2.26187 |
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