Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study

Abstract

Background Alcohol use in HIV infected patients is associated with risky sexual behaviour, poor adherence to Highly Active Antiretroviral Therapy, treatment failure and increased physiologic harm. The objectives of the study were to pilot the outcome assessments to be used in the trial proper, assess the feasibility of delivery of a brief MI/CBT intervention compared to an WHO mhGAP intervention for problematic alcohol use in PLWH in Zimbabwe, and pilot the effectiveness (on alcohol use, functionality and CD4 count) of these interventions at 3 months in a randomised controlled trial design. Methods An intervention for HIV infected patients with problematic alcohol use, developed through adaptation of existing evidence based psychological treatments, was assessed for its feasibility at a tertiary HIV care clinic in Zimbabwe. Registered general nurses, using a manualised protocol, delivered the intervention. Forty patients were recruited and randomised to receive either an MI/CBT intervention or the WHO mhGAP Intervention Guide for AUDs (n = 20 patients per group). Results Out of 40 participants enrolled, 31 were successfully followed up for 3 months with a loss to follow-up rate of 23%. There was a statistically significant decrease in AUDIT score over time in both groups ( p < 0.001), however no statistically significant group difference with a mean difference of 0.80, standard error of 2.07 and p = 0.70. For the CD4 count, the median and interquartile ranges at baseline for MI/CBT and WHO mhGAP IG groups were 218 (274) and 484 (211.50), respectively. At follow-up, median and interquartile ranges for the CD4 count for MI/CBT and WHO mhGAP IG groups were 390 (280) and 567 (378), respectively, indicative of improvement in immunological parameters in both arms. Conclusion The findings from this pilot study suggests that a brief MI/CBT delivered by Registered General Nurses for problematic alcohol use is feasible in this population but will require the implementation of additional measures to improve retention. However, mechanisms to improve retention need special attention. Trial registration Pan African Clinical Trial Registry, current PACTR201509001211149

The prevalence and factors associated with alcohol use disorder among people living with HIV/AIDS in Africa: a systematic review and meta-analysis

“…In Ethiopia studies conducted so far implied that AUD among HIV/AIDS patients was documented to be 32.6% in Jimma university specialized hospital [25], and 31.8% in Hawassa university comprehensive hospital [26], 14.2% in Bishoftu general hospital [27], 24.8% in Assela teaching hospital [28]. Moreover, a systematic review and meta-analysis study of alcohol consumption in Ethiopia by Ayano et al2019 [29] reported that the prevalence of hazardous alcohol consumption was 8.96%.…”

“…Other earlier studies in Africa reported that the prevalence of AUD ranges from 17 to 39.4% in Nigeria [8][9][10], 1.4 to 33% in Uganda [11][12][13][14], 6.6 to 48.5% in South Africa [15][16][17][18], 5.4 to 33% in Kenya [19][20][21][22], and 14.8% in Zambia [23]. There exists a scarcity of average data on alcohol use disorders in people with HIV in other African countries despite the high disease burden with people living with HIV (PLWHA) [24].…”

Prevalence and factors associated with Alcohol Use Disorder among People Living with HIV/AIDS in Africa: A systematic review and Meta-analysis.

“…Other earlier studies in Africa reported that the prevalence of AUD ranges from 17% to 39.4% in Nigeria (8-10) ,1.4% to 33% in Uganda (11)(12)(13)(14),6.6% to 48.5% in South Africa (15)(16)(17)(18) ,5.4% to 33% in Kenya (19)(20)(21)(22), and 14.8% in Zambia (23). There exists a scarcity of average data on alcohol use disorders in people with HIV in other African countries despite the high disease burden with people living with HIV(PLWHA) (24).…”

“…In Ethiopia studies conducted so far implied that AUD among HIV/AIDS patients was documented to be 32.6% in Jimma university specialized hospital (25), and 31.8% in Hawassa university comprehensive hospital (26), 14.2% in Bishoftu general hospital (27), 24.8% in Assela teaching hospital (28). Moreover, a systematic review and meta-analysis study of alcohol consumption in Ethiopia by Ayano et al2019 (29) reported that the prevalence of hazardous alcohol consumption was 8.96%.…”

A Systematic Review and Meta-analysis of Alcohol Use Disorders and Its determinants in People Living with HIV in Africa: A Continent based Review and Meta-analysis study.

“…Earlier studies reported that the prevalence of alcohol use disorder ranges from 17-39.4% in Nigeria (8-10) ,1.4-33% in Uganda (11)(12)(13)(14), 6.6-48.5% in south Africa (15-18), 5.4-33% in Kenya (19)(20)(21)(22), and 14.8% in Zambia (23). There Exists a scarcity of data on alcohol use disorders in people with HIV in other African countries despite the high disease burden with many people living with HIV (24).…”