Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya

Rebecca K Papas, John E Sidle, Benson N Gakinya, Joyce B Baliddawa, Steve Martino, Michael M Mwaniki, Rogers Songole, Otieno E Omolo, Allan M Kamanda, David O Ayuku, Claris Ojwang, Willis D Owino-Ong'or, Magdalena Harrington, Kendall J Bryant, Kathleen M Carroll, Amy C Justice, Joseph W Hogan, Stephen A Maisto, Rebecca K Papas, John E Sidle, Benson N Gakinya, Joyce B Baliddawa, Steve Martino, Michael M Mwaniki, Rogers Songole, Otieno E Omolo, Allan M Kamanda, David O Ayuku, Claris Ojwang, Willis D Owino-Ong'or, Magdalena Harrington, Kendall J Bryant, Kathleen M Carroll, Amy C Justice, Joseph W Hogan, Stephen A Maisto

Abstract

Aims: Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected out-patients in Eldoret, Kenya.

Design: Randomized clinical trial comparing CBT against a usual care assessment-only control.

Setting: A large HIV out-patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration.

Participants: Seventy-five HIV-infected out-patients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking.

Measurements: Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method.

Findings: There were 299 ineligible and 102 eligible out-patients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large [d=0.95, P=0.0002, mean difference=24.93, 95% confidence interval (CI): 12.43, 37.43 PDD; d=0.76, P=0.002, mean difference=2.88, 95% CI: 1.05, 4.70 DDD]. Randomized participants attended 93% of the six CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69% (CBT) and 38% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the United States. Treatment effect sizes were comparable to alcohol intervention studies conducted in the United States.

Conclusions: Cognitive-behavioral therapy can be adapted successfully to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan out-patients.

Conflict of interest statement

Conflict of interest declaration: None

© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Figures

Figure 1
Figure 1
CONSORT diagram of eligibility, enrollment, randomization, treatment, and follow-up rates. CBT=cognitive behavioral therapy; Control=usual care condition.
Figure 2
Figure 2
Repeated measures regression coefficients and observed means of percent drinking days across three study phases: Initial Reactivity (Baseline-Week 2), Treatment (Weeks 3–6) and follow-up (Weeks 7–18). CBT=cognitive behavioral therapy UC=usual care control. Note: baseline represents previous 30 days
Figure 3
Figure 3
Repeated measures regression coefficients and observed means of average drinks per drinking day across three study phases: Initial Reactivity (Baseline-Week 2), Treatment (Weeks 3–6) and follow-up (Weeks 7–18). CBT=cognitive behavioral therapy UC=usual care control. Note: baseline represents previous 30 days

Source: PubMed

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