“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

Myers, Bronwyn; Parry, Charles D. H.; Morojele, Neo K.; Nkosi, Sebenzile; Shuper, Paul A.; Kekwaletswe, Connie T.; Sorsdahl, Katherine

doi:10.3390/ijerph17165706

Cited by 9 publications

(7 citation statements)

References 44 publications

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“…Integrating AOD treatment into HIV care can improve ART adherence, yet this is not typically routine practice in SA or other low-resource settings [15][16][17]. Furthermore, ART adherence interventions are rarely adapted for AODa missed opportunity for maximizing HIV treatment outcomes [18][19][20][21][22][23].…”

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confidence: 99%

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

et al. 2021

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Introduction South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low‐resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. Methods A pilot randomized hybrid type 1 effectiveness‐implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task‐shared, peer‐delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on‐site AOD treatment. Implementation outcomes, defined by Proctor’s model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post‐treatment (three months) measured via real‐time electronic adherence monitoring, and AOD measured using biomarker and self‐report assessments over six months. Data collection was conducted from August 2018 to April 2020. Results and discussion Ninety‐one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment‐by‐time interaction for ART adherence (estimate = −0.287 [95% CI = −0.507, −0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self‐reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow‐back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). Conclusions Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non‐adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task‐sharing models for behavioral health in resource‐limited, global settings.

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confidence: 99%

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

et al. 2021

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“…Ultimately, 35 full-text articles were included in this review. Several relevant protocol [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], baseline or pilot [ 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], and feasibility studies [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ] were identified; however, they did not meet the inclusion criteria because trial outcomes were the focus of this review.…”

Section: Methodsmentioning

confidence: 99%

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

Wechsberg

Drift

Howard

et al. 2022

IJERPH

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Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.

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“…Among patients with diabetes, combining information provision, MI techniques, and meaningful relationships led to improved sense of control [30], while others reported that it drove optimism [31]. Provision of information combined with MI techniques was also identified as two intervention components perceived as most beneficial in people receiving antiretroviral therapy [32]. Consistent with this, our study shows that the availability of tailored, accurate, up-to-date, and complete information on how to cope with AET-related issues as well as breast cancer women's involvement in care, coupled with the ongoing, timely support from nurse navigators, created synergies that were perceived to grow women's empowerment and optimism for the long-term intake of AET.…”

Section: Key Findingsmentioning

confidence: 99%

Women with breast cancer’s perceptions of nurse-led telephone-based motivational interviewing consultations to enhance adherence to adjuvant endocrine therapy: a qualitative study

Gagné

Lauzier

Lemay

et al. 2022

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Background Daily adjuvant endocrine therapy (AET) for 5 or 10 years is the standard of care for women diagnosed with non-metastatic hormone receptor-positive breast cancer. However, many women experience AET-related issues that may hamper quality of life and adherence. Here, we aimed to describe women's perceptions of motivational interviewing (MI)guided consultations delivered by a trained nurse navigator over the telephone to enhance AET adherence. Methods Eighteen women who were first prescribed AET for non-metastatic breast cancer in the last 5 years, who selfreported AET-related issues, and who participated in at least two MI-guided consultations over a year were interviewed about their perceptions of the intervention, using a semi-structured interview guide. Audio recordings were transcribed verbatim and analyzed using a thematic analysis approach. Results Three main themes emerged from the data about women's perceptions on MI-guided consultations. These consultations were described as (1) a person-centred experience, (2) providing key information about AET, and (3) supportive of present and future AET experience, by contributing to AET side-effect management, motivation, adherence, calming negative emotions, improving well-being and self-esteem, and making women to feel empowered. Conclusions Nurse-led telephone-based MI-guided consultations about AET were found to respond to participants' needs and to enhance participants' perceptions of being informed and being supported in experiencing various facets of AET. Telephone-based consultations for AET are perceived as a promising strategy in an increasing virtual care world.

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“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

Cited by 9 publications

References 44 publications

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

Project Khanya: results from a pilot randomized type 1 hybrid effectiveness‐implementation trial of a peer‐delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

Women with breast cancer’s perceptions of nurse-led telephone-based motivational interviewing consultations to enhance adherence to adjuvant endocrine therapy: a qualitative study

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