Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya

Papas, Rebecca K.; Sidle, John E.; Martino, Steve; Baliddawa, Joyce; Songole, Rogers; Omolo, Otieno E.; Gakinya, Benson N.; Mwaniki, Michael M.; Adina, Japheth O.; Nafula, Tobista; Owino-Ong'or, Willis; Bryant, Kendall; Carroll, Kathleen M.; Goulet, Joseph L.; Justice, Amy C.; Maisto, Stephen A.

doi:10.1007/s10461-009-9647-6

Cited by 64 publications

(72 citation statements)

References 28 publications

(28 reference statements)

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“…As they are substantially easier to calculate than the beverage-specific grams of alcohol, these measures may provide a simpler alternative to measuring drinking in this setting. Non-volume measures also may aid recall; heavy drinkers can forget volumes (Northcote and Livingston, 2011), but may, in theory, be more likely to remember their expenditure (Papas et al, 2010a) or degree of intoxication. In particular, the AUDIT-C, FGF grams of alcohol, and QF grams of alcohol had similar correlations with PEth.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

Asiimwe

Fatch

Emenyonu

et al. 2015

Alcohol Clin Exp Res

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Background In sub-Saharan Africa (SSA), HIV-infected patients may under-report alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel non-volume measures, and the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). Methods We analyzed cohort-entry data from the Biomarker Research of Ethanol in Those with HIV cohort study (2011-2013). Participants were HIV-infected past year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman’s rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CI) for pairwise differences between coefficients. Results A total of 209 subjects (57% male) were included. Median age was 30; inter-quartile range (IQR) 25-38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2137) were higher than QF grams (375, IQR 33 to 1776), p<0.001. However, both measures were moderately correlated with PEth; rho = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference −0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (rho = 0.35 to 0.57). Conclusion HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed, suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other non-volume measures may provide simpler alternatives.

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Section: Discussionmentioning

confidence: 99%

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

Asiimwe

Fatch

Emenyonu

et al. 2015

Alcohol Clin Exp Res

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“…Cognitive behavioral therapy (CBT)-based interventions have been shown to be effective in reducing alcohol use among people with HIV/AIDS [58], and related interventions can be effectively adapted for different cultures [59]. Previous work has effectively targeted ART adherence among harmful alcohol users with CBT and motivational interviewing skills; however, alcohol use was not significantly impacted [60].…”

Section: Alcoholmentioning

confidence: 99%

Substance Use: Impact on Adherence and HIV Medical Treatment

2011

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Substance use is highly prevalent among people living with HIV/AIDS, is often comorbid with other mental health problems, related to poor HIV medical outcomes, and, is associated with poor medication and treatment adherence. The current review reports on the recent state of the literature in terms of substance use and its relation to HIV medication and treatment adherence, and offers recommendations for advancing treatment and secondary HIV prevention efforts. Identifying substance users within HIV primary care and developing, evaluating, and refining integrative substance use-mental health-adherence interventions may be clinically important targets for effective disease management and may contribute to secondary HIV prevention efforts.

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“…Nearly half of these alcohol-attributable infections could be averted by an alcohol intervention program with the same effectiveness as CBT-based interventions (Papas et al, 2010), assuming that the effect persists. Such an alcohol intervention would also reduce the mortality by 2.3%.…”

Section: Discussionmentioning

confidence: 99%

Impact of Interventions Targeting Unhealthy Alcohol Use in Kenya on HIV Transmission and AIDS‐Related Deaths

Braithwaite

Nucifora

Kessler

et al. 2014

Alcoholism Clin & Exp Res

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Background HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. Methods We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol’s effects on HIV transmission and progression (e.g. lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). Results Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy (CBT)-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol’s underlying effects on condom use, antiretroviral therapy adherence, and STI prevalence Conclusions A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5 percent and avert over 15,000 deaths related to HIV.

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Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya

Cited by 64 publications

References 28 publications

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

Substance Use: Impact on Adherence and HIV Medical Treatment

Impact of Interventions Targeting Unhealthy Alcohol Use in Kenya on HIV Transmission and AIDS‐Related Deaths

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