A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya.

Autor: Papas RK; Alpert Medical School of Brown University, Providence, RI, USA., Gakinya BN; School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya., Mwaniki MM; Academic Model providing Access to Healthcare (AMPATH), Eldoret, Kenya., Lee H; Brown University School of Public Health, Providence, RI, USA., Keter AK; Academic Model providing Access to Healthcare (AMPATH), Eldoret, Kenya., Martino S; Yale University School of Medicine, New Haven, CT, USA., Klein DA; Right Response LLC, Minneapolis, MN, USA., Liu T; Brown University School of Public Health, Providence, RI, USA., Loxley MP; Brown University School of Public Health, Providence, RI, USA., Sidle JE; Indiana University School of Medicine, Indianapolis, IN, USA., Schlaudt K; Lutheran World Foundation, Gore, Chad., Nafula T; Academic Model providing Access to Healthcare (AMPATH), Eldoret, Kenya., Omodi VM; Academic Model providing Access to Healthcare (AMPATH), Eldoret, Kenya., Baliddawa JB; School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya., Kinyanjui DW; School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya., Maisto SA; Syracuse University, Syracuse, NY, USA.
Jazyk: angličtina
Zdroj: Addiction (Abingdon, England) [Addiction] 2021 Feb; Vol. 116 (2), pp. 305-318. Date of Electronic Publication: 2020 Jul 13.
DOI: 10.1111/add.15112
Abstrakt: Background and Aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub-Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive-behavioral therapy (CBT) intervention to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya.
Design: Randomized clinical trial.
Setting: A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration.
Participants: A total of 614 HIV-infected outpatients [312 CBT; 302 healthy life-styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking.
Intervention and Comparator: A culturally adapted six-session gender-stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90-minute sessions with a 9-month follow-up.
Measurements: Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time-line follow-back from baseline to 9 months post-intervention. Exploratory analyses examined unprotected sex and number of partners.
Findings: Median attendance was six sessions across condition. Retention at 9 months post-intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD - CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 - 4.04; DDD - CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 - 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1-month follow-up.
Conclusions: A cognitive-behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV-infected Kenyan outpatient drinkers.
(© 2020 Society for the Study of Addiction.)
Databáze: MEDLINE
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