Treatment outcomes of a stage 1 cognitive–behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya
Article first published online: 18 AUG 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 106, Issue 12, pages 2156–2166, December 2011
How to Cite
Papas, R. K., Sidle, J. E., Gakinya, B. N., Baliddawa, J. B., Martino, S., Mwaniki, M. M., Songole, R., Omolo, O. E., Kamanda, A. M., Ayuku, D. O., Ojwang, C., Owino-Ong'or, W. D., Harrington, M., Bryant, K. J., Carroll, K. M., Justice, A. C., Hogan, J. W. and Maisto, S. A. (2011), Treatment outcomes of a stage 1 cognitive–behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction, 106: 2156–2166. doi: 10.1111/j.1360-0443.2011.03518.x
- Issue published online: 3 NOV 2011
- Article first published online: 18 AUG 2011
- Accepted manuscript online: 1 JUN 2011 06:05AM EST
- Submitted 18 November 2010; initial review completed 27 January 2011; final version accepted 20 May 2011
- cognitive-behavioral therapy;
- randomized clinical trial
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.