Cultural Adaptation of 2 Evidence-Based Alcohol Interventions for Antiretroviral Treatment Clinic Patients in Vietnam

Abstract

In Vietnam where alcohol use is culturally normative and little treatment is available, persons living with HIV (PLWH) who consume alcohol at unhealthy levels are at greatly increased risk for negative health outcomes. We describe the first systematic adaptation of 2 evidence-based alcohol interventions for use in Vietnam: a combined motivational enhancement therapy/cognitive behavioral therapy and a brief alcohol intervention. Using the situated information, motivation and behavioral skills model, and systematic procedures for tailoring evidence-based treatments, we identified core intervention content to be preserved and key characteristics to be tailored for relevance to the clinical setting. We describe the use of in-depth interviews with antiretroviral treatment clients and providers, expert input, and counselor training procedures to develop tailored manuals for counselors and clients. Adapting evidence-based alcohol treatments for global settings is facilitated by the use of a model of behavior change and systematic procedures to operationalize the approach.

Effect of 2 Integrated Interventions on Alcohol Abstinence and Viral Suppression Among Vietnamese Adults With Hazardous Alcohol Use and HIV

“…The processes for selecting and culturally adapting the 2 interventions are described in detail elsewhere. 27 We conducted training and provided supervision through weekly meetings using a completion checklist and the Yale Adherence and Competence Scale (YACS; range 1-7, with 7 indicating excellent fidelity) 28 to ensure sessions were standardized across our team of paraprofessional counselors who delivered the interventions. A team of 2 counselors, 1 woman and 1 man, was assigned to the combined intervention group, and a different counseling team, 1 woman and 1 man, was assigned to the brief intervention group.…”

“…The combined intervention and brief intervention have been highly effective in reducing alcohol use among people living with HIV with hazardous or heavy alcohol use in US settings 24 , 25 , 26 and were selected for their potential applicability to the Vietnamese context. 27 …”

Implementation of two alcohol reduction interventions among persons with hazardous alcohol use who are living with HIV in Thai Nguyen, Vietnam: a micro-costing analysis

“…The SOC in Vietnam is a verbal referral to a substance use provider; given that this is the existing approach in the country it was not possible to identify the costs and thus is outside the scope of this analysis. The interventions are described in detail elsewhere [ 21 ]. Briefly, the CoI draws from motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) using a client-centered, motivational approach where clients focus on skills-building for alcohol use behavior change, including drinking refusal skills, skills to cope with and manage cravings and triggers, and developing positive thoughts and attitudes.…”

“…The findings from the formative research informed the adaptation of manuals from a previously implemented evidence-based US-based study [ 22 ]. One intervention manual for the CoI and one intervention manual for the BI were developed by the US-based subject matter expert, incorporating comments from the US and Vietnam teams [ 21 ]. The development of the manuals and corresponding handbooks included design, logo creation, printing of notebooks for clients and counselors, and translation.…”

Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam

“…This study is a secondary analysis of data from a three-arm randomized controlled trial (RCT) comparing the effects of two evidence-based, manually guided, individually delivered interventions to reduce alcohol use and determine the impact on viral load [42,43]. From March 2016 to May 2018, data were collected from clinic patients with HIV and hazardous alcohol use (N = 440) in Thai Nguyen, a semi-urban province in northern Vietnam [42].…”