Alcohol consumption is a critical driver of HIV outcomes, especially in sub-Saharan Africa (SSA), where both are extremely common. Heavy alcohol use has been associated with reduced antiretroviral adherence, decreased HIV suppression, and increased mortality among those with HIV. Thus, reducing unhealthy alcohol use may improve HIV outcomes and is a high priority worldwide and to the NIAAA. Thus, the overall goal of the EXTEND Study (R01 AA024090, 4 years) is to adapt a brief pragmatic intervention to reduce alcohol use, leveraging cell phone technology to conduct booster sessions between HIV clinic visits, and to conduct a randomized controlled trial comparing 3 arms. Arm 1 is comprised of in-person counselling (two sessions) plus live phone calls by counsellors monthly between in-person sessions; Arm 2 is comprised of in-person counselling (two sessions) plus cell-phone delivered automated 2-way booster sessions delivered twice weekly between in-person sessions; and Arm 3 is standard of care. We request an administrative supplement for the following activities. (1). We propose to add additional phosphatidylethanol (PEth) testing and self- reported alcohol measures to occur immediately after intervention completion (at approximately 3 months) to enable us assess short-term changes in drinking. This assessment will be consistent with recent findings that suggest that the largest reductions in alcohol use occur during the first months after intervention and our additional assessment would provide an opportunity to capture these data. (2) Because of the low literacy level of our study participants, the technology development was slower than anticipated. Additional resources are requested to further develop the technology for the study participants with low literacy, using interactive voice response (IVR) technology used to deliver counseling booster sessions for participants with low-literacy. Upgrades to the technology will enable us improve upon this novel mode of intervention delivery in a resource-limited setting that is inclusive of all participants in the population regardless of their literacy levels. (3) Finally, we propose to increase the personnel effort of team to expand analytical and program management support needed to accomplish these goals. The proposed supplement is consistent with the original aims of the R01, which is to develop and test interventions to reduce alcohol consumption and improve HIV outcomes that can be feasibly integrated into routine HIV care in sub-Saharan Africa. The proposed supplement will enable us deliver the study intervention equitably to all study participants and will provide an opportunity for us to assess the short-term impact of the intervention, and ultimately improve the quality and productivity of the research. .
Alcohol consumption is a critical driver of HIV outcomes, especially in sub-Saharan Africa (SSA), where both are extremely common. Multi-session interventions that combine in-person visits with booster phone calls to reinforce the in-person counseling have shown good efficacy for reducing alcohol use, but can be costly and have unknown impact on HIV outcomes. Thus, the long-term goal of this research is to develop and test interventions to reduce alcohol consumption and improve HIV outcomes, that can be feasibly integrated into routine HIV care in sub-Saharan Africa.
