Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa

Gichane, Margaret W.; Wechsberg, Wendee M.; Ndirangu, Jacqueline; Browne, Felicia; Bonner, Courtney Peasant; Grimwood, Ashraf; Shaikh, Najma; Howard, Brittni Nicole; Zule, William

doi:10.1016/j.drugalcdep.2020.108206

Cited by 10 publications

(17 citation statements)

References 34 publications

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“…As the importance of recognizing gender differences in intervention research increases, alcohol use in gender-related behavioral HIV prevention intervention research in the era of ART is essential to understanding intersectional risks and advancement. After numerous previous efficacy trials with the WHC, for this study, the WHC was implemented in usual care settings by trained healthcare staff and found acceptable [ 35 ]; however, these study outcomes focus on intervention effectiveness on ART adherence and alcohol reduction. While three-fourths of the participants at baseline were taking ART, our findings show that the WHC increased ART adherence and reduced alcohol use.…”

Section: Discussionmentioning

confidence: 99%

“…Although intervention fidelity was high [ 35 ] and the information about the personalized action plan was presented and participants encouraged to develop their action plans, which is a core element of the intervention [ 40 ], action plans were not delivered consistently because of clinic schedules and time. However, by Cycle 3, the personalized plan component was effective and implemented more consistently at the closing of the workshop where the goals were discussed overall, with the intention of empowering women to improve their lives.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, it examines the impact of the intervention on the patient-level outcomes of risk for alcohol use disorder and ART adherence. The appropriateness, acceptability, and feasibility of the WHC in usual care settings have been reported previously [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

et al. 2021

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Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country’s 90-90-90 targets. The Women’s Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

et al. 2021

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“…Yet, intervention research cannot be everything to all. We also need to listen to women's stories, consider gendered measures and stratified approaches, empower women be more educated about their HIV status, reduce barriers to ART and alcohol treatment, measure efficacy and effectiveness to know what will work, and identify mediators and moderators that affect change to ultimately understand what can be sustained in the real world [91]. Gender matters and women matter because they are mothers of the next generation.…”

Section: Discussionmentioning

confidence: 99%

Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters

et al. 2021

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Purpose of Review Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH examines how these studies considered gender in the samples, design, and analyses. Recent Findings Three searches were conducted initially, and 13 intervention studies fit our criteria with alcohol outcomes. In general, most studies did not consider gender and had used small samples, and few demonstrated significant efficacy/effectiveness outcomes. Five studies considered gender in their samples or analyses and/or were woman-focused with larger samples and demonstrated significant outcomes. Summary It is essential for women who misuse alcohol to not only be well represented in alcohol and HIV research but also for studies to consider the barriers to reaching them and their contextual demands and/or co-occurring issues that may affect participation and outcomes in intervention research.

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“…A recently completed implementation science trial in South Africa [9][10][11] to improve ART adherence and reduce alcohol use among women with HIV enrolled a total of 480 women recruited via HIV testing and counseling (HTC) clinics and substance use rehabilitation centers in economically disadvantaged communities in Cape Town, South Africa. A modified stepped-wedge design was applied in which each HTC clinic was paired with a substance use rehabilitation center and each pair was randomized by computer to one of four implementation cycles [10].…”

Section: Methodsmentioning

confidence: 99%

Antiretroviral Therapy (ART) Adherence and Prenatal Alcohol Use among Women Who Are Pregnant with HIV in South Africa

Washio

Browne

Ndirangu

et al. 2021

IJERPH

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This brief report emphasizes the need to focus on women with HIV who are pregnant who use alcohol or other drugs. A recently completed implementation science study tested a gender-focused behavioral intervention, the Women’s Health CoOp (WHC), to improve antiretroviral therapy (ART) adherence and reduce alcohol use among women with HIV. The study identified 33 participants who had a positive pregnancy test result at the baseline assessment, of whom five participants remained pregnant during the 6-month duration of the study. Of the 33 pregnant participants at the baseline assessment, 55% reported past-month alcohol use, with 27% reporting a history of physical abuse and 12% reporting a history of sexual abuse. The five women who remained pregnant at 6 months showed improved ART adherence and reduced prenatal alcohol use. The gender-focused WHC intervention shows promise as a cost-effective, sustainable, behavioral intervention to address these intersecting syndemic issues. Future research should focus on identifying the needs of women with HIV who are pregnant who use alcohol or other drugs and developing tailored evidence-based behavioral interventions such as the WHC for preventing FASD in addition to improving ART adherence in this key population of women and reducing the economic burden on society.

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Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa

Cited by 10 publications

References 34 publications

Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters

Antiretroviral Therapy (ART) Adherence and Prenatal Alcohol Use among Women Who Are Pregnant with HIV in South Africa

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