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 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

Research output: Contribution to journalArticle

45 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2156-2166
Number of pages11
JournalAddiction
Volume106
Issue number12
DOIs
StatePublished - Dec 2011

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Kenya
Cognitive Therapy
Outpatients
Alcohols
Drinking
HIV
Alcohol Abstinence
Confidence Intervals
Binge Drinking
Africa South of the Sahara
Mental Competency
Randomized Controlled Trials
Delivery of Health Care
Therapeutics

Keywords

  • Alcohol
  • Cognitive-behavioral therapy
  • HIV
  • Kenya
  • Randomized clinical trial

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health
  • Medicine(all)

Cite this

Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. / Papas, Rebecca K.; Sidle, John; Gakinya, Benson N.; Baliddawa, Joyce B.; Martino, Steve; Mwaniki, Michael M.; Songole, Rogers; Omolo, Otieno E.; Kamanda, Allan M.; Ayuku, David O.; Ojwang, Claris; Owino-Ong'or, Willis D.; Harrington, Magdalena; Bryant, Kendall J.; Carroll, Kathleen M.; Justice, Amy C.; Hogan, Joseph W.; Maisto, Stephen A.

In: Addiction, Vol. 106, No. 12, 12.2011, p. 2156-2166.

Research output: Contribution to journalArticle

Papas, RK, Sidle, J, Gakinya, BN, Baliddawa, JB, Martino, S, Mwaniki, MM, Songole, R, Omolo, OE, Kamanda, AM, Ayuku, DO, Ojwang, C, Owino-Ong'or, WD, Harrington, M, Bryant, KJ, Carroll, KM, Justice, AC, Hogan, JW & Maisto, SA 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, vol. 106, no. 12, pp. 2156-2166. https://doi.org/10.1111/j.1360-0443.2011.03518.x
Papas, Rebecca K. ; Sidle, John ; Gakinya, Benson N. ; Baliddawa, Joyce B. ; Martino, Steve ; Mwaniki, Michael M. ; Songole, Rogers ; Omolo, Otieno E. ; Kamanda, Allan M. ; Ayuku, David O. ; Ojwang, Claris ; Owino-Ong'or, Willis D. ; Harrington, Magdalena ; Bryant, Kendall J. ; Carroll, Kathleen M. ; Justice, Amy C. ; Hogan, Joseph W. ; Maisto, Stephen A. / Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. In: Addiction. 2011 ; Vol. 106, No. 12. pp. 2156-2166.
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AU - Ayuku, David O.

AU - Ojwang, Claris

AU - Owino-Ong'or, Willis D.

AU - Harrington, Magdalena

AU - Bryant, Kendall J.

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N2 - 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.

AB - 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.

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