Motivational interviewing and problem-solving therapy intervention for patients on antiretroviral therapy for HIV in Tshwane, South Africa: A randomized controlled trial to assess the impact on alcohol consumption.

Journal: Addiction (Abingdon, England)

Volume: 118

Issue: 11

Year of Publication: 2023

Affiliated Institutions:  Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa. Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa and Department of Statistics, University of Pretoria, Pretoria, South Africa. Department of Medicine, University of California San Francisco, San Francisco, California, USA. Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

Abstract summary 

Reduction of alcohol consumption is important for people undergoing treatment for HIV. We tested the efficacy of a brief intervention for reducing the average volume of alcohol consumed among patients on HIV antiretroviral therapy (ART).This study used a two-arm multi-centre randomized controlled trial with follow-up to 6 months. Recruitment occurred between May 2016 and October 2017 at six ART clinics at public hospitals in Tshwane, South Africa. Participants were people living with HIV, mean age 40.8 years [standard deviation (SD) = 9.07], 57.5% female, and on average 6.9 years (SD = 3.62) on ART. At baseline (BL), the mean number of drinks consumed over the past 30 days was 25.2 (SD = 38.3). Of 756 eligible patients, 623 were enrolled.Participants were randomly assigned to a motivational interviewing (MI)/problem-solving therapy (PST) intervention arm (four modules of MI and PST delivered over two sessions by interventionists) or a treatment as usual (TAU) comparison arm. People assessing outcomes were masked to group assignment.The primary outcome was the number of standard drinks (15 ml pure alcohol) consumed during the past 30 days assessed at 6-month follow-up (6MFU).Of the 305 participants randomized to MI/PST, 225 (74%) completed the intervention (all modules). At 6MFU, retention was 88% for the control and 83% for the intervention arm. In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6MFU was -0.410 (95% confidence interval = -0.670 to -0.149) units lower on log scale in the intervention group than in the control group (P = 0.002), a 34% relative reduction in the number of drinks. Sensitivity analyses were undertaken for patients who had alcohol use disorders identification test (AUDIT) scores ≥ 8 at BL (n = 299). Findings were similar to those of the whole sample.In South Africa, a motivational interviewing/problem-solving therapy intervention significantly reduced drinking levels in HIV-infected patients on antiretroviral therapy at 6-month follow-up.

Authors & Co-authors:  Parry Charles D H CDH Myers Bronwyn B Londani Mukhethwa M Shuper Paul A PA Janse van Rensburg Charl C Manda Samuel O M SOM Nkosi Sebenzile S Kekwaletswe Connie T CT Hahn Judith A JA Rehm Jürgen J Sorsdahl Katherine K Morojele Neo K NK

Study Outcome 

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Statistics
Citations :  Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta‐analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.
Authors :  12
Identifiers
Doi : 10.1111/add.16278
SSN : 1360-0443
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
Alcohol;PLWHIV;South Africa;brief intervention;problem-solving therapy
Study Design
Randomized Control Trial,Case Control Trial,Cross Sectional Study
Study Approach
Country of Study
South Africa
Publication Country
England