TY - JOUR
T1 - Alcohol-focused and transdiagnostic treatments for unhealthy alcohol use among adults with HIV in Zambia
T2 - A 3-arm randomized controlled trial
AU - Vinikoor, Michael J.
AU - Sharma, Anjali
AU - Murray, Laura K.
AU - Figge, Caleb J.
AU - Bosomprah, Samuel
AU - Chitambi, Chipo
AU - Paul, Ravi
AU - Kanguya, Tukiya
AU - Sivile, Suilanji
AU - Nghiem, Van
AU - Cropsey, Karen
AU - Kane, Jeremy C
N1 - Funding Information:
This study was funded by the National Institute of Alcohol Abuse and Alcoholism at the U.S. National Institutes of Health ( P01AA029540 and K01AA026523 ).
Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - Background: Clinical and quality of life outcomes in people living with human immunodeficiency virus (PLWH) are undermined by unhealthy alcohol use (UAU), which is highly prevalent in this population and is often complicated by mental health (MH) or other substance use (SU) comorbidity. In sub-Saharan Africa, evidence-based and implementable treatment options for people with HIV and UAU are needed. Methods: We are conducting a hybrid clinical effectiveness-implementation trial at three public-sector HIV clinics in Lusaka, Zambia. Adults with HIV, who report UAU, and have suboptimal HIV clinical outcomes, will be randomized to one of three arms: an alcohol-focused brief intervention (BI), the BI with additional referral to a transdiagnostic cognitive behavioral therapy (Common Elements Treatment Approach [CETA]), or standard of care. The BI and CETA will be provided by HIV peer counselors, a common cadre of lay health worker in Zambia. Clinical outcomes will include HIV viral suppression, alcohol use, assessed by audio computer-assisted self-interview (ACASI) and direct alcohol biomarkers, Phophatidylethanol and Ethyl glucuronide, and comorbid MH and other SU. A range of implementation outcomes including cost effectiveness will also be analyzed. Conclusion: Hybrid and 3-arm trial design features facilitate the integrated evaluation of both brief, highly implementable, and more intensive, less implementable, treatment options for UAU among PLWH in sub-Saharan Africa. Use of ACASI and alcohol biomarkers will strengthen understanding of treatment effects.
AB - Background: Clinical and quality of life outcomes in people living with human immunodeficiency virus (PLWH) are undermined by unhealthy alcohol use (UAU), which is highly prevalent in this population and is often complicated by mental health (MH) or other substance use (SU) comorbidity. In sub-Saharan Africa, evidence-based and implementable treatment options for people with HIV and UAU are needed. Methods: We are conducting a hybrid clinical effectiveness-implementation trial at three public-sector HIV clinics in Lusaka, Zambia. Adults with HIV, who report UAU, and have suboptimal HIV clinical outcomes, will be randomized to one of three arms: an alcohol-focused brief intervention (BI), the BI with additional referral to a transdiagnostic cognitive behavioral therapy (Common Elements Treatment Approach [CETA]), or standard of care. The BI and CETA will be provided by HIV peer counselors, a common cadre of lay health worker in Zambia. Clinical outcomes will include HIV viral suppression, alcohol use, assessed by audio computer-assisted self-interview (ACASI) and direct alcohol biomarkers, Phophatidylethanol and Ethyl glucuronide, and comorbid MH and other SU. A range of implementation outcomes including cost effectiveness will also be analyzed. Conclusion: Hybrid and 3-arm trial design features facilitate the integrated evaluation of both brief, highly implementable, and more intensive, less implementable, treatment options for UAU among PLWH in sub-Saharan Africa. Use of ACASI and alcohol biomarkers will strengthen understanding of treatment effects.
KW - HIV
KW - Phosphatidylethanol
KW - Sub-Saharan Africa
KW - Transdiagnostic therapy
KW - Unhealthy alcohol use
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U2 - 10.1016/j.cct.2023.107116
DO - 10.1016/j.cct.2023.107116
M3 - Article
C2 - 36791907
AN - SCOPUS:85148674150
SN - 1551-7144
VL - 127
JO - Contemporary Clinical Trials
JF - Contemporary Clinical Trials
M1 - 107116
ER -