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Conroy AA, Hahn JA, Neilands TB, Darbes LA, Tebbetts S, Mulauzi N, Mkandawire J, Ssewamala FM. Pilot Trial Results of Mlambe: An Economic and Relationship-Strengthening Intervention to Address Heavy Drinking and Adherence to Antiretroviral Therapy in Malawi. AIDS Behav 2024; 28:2296-2306. [PMID: 38551718 DOI: 10.1007/s10461-024-04326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/01/2024]
Abstract
We evaluated the feasibility, acceptability, and preliminary efficacy of an economic and relationship-strengthening intervention to reduce heavy alcohol use among couples living with HIV in Malawi (Mlambe). Mlambe consisted of training on financial literacy and relationship skills, combined with 1:1 matched savings accounts to invest in an income-generating activity. In a randomized controlled trial, we compared Mlambe to enhanced usual care (EUC). We enrolled 78 married couples having a partner on antiretroviral therapy (ART) who reported heavy alcohol use based on the AUDIT-C. Using targets of 75%, primary outcomes included retention rates at 10 and 15-months, session attendance rates, and satisfaction with Mlambe. Exploratory outcomes were heavy alcohol use (AUDIT-C and/or PEth positive), number of drinking days in the past month, AUDIT-C score, optimal adherence to ART (95% or higher), and viral suppression. We exceeded our targets for feasibility and acceptability metrics. Retention rates were 96% at 15-months. Session attendance and satisfaction levels were both 100%. From baseline to 15-months, Mlambe participants reported decreases in mean number of drinking days (from 6.8 to 2.1) and AUDIT-C scores (from 7.5 to 3.1); while ART adherence rates improved across the same period (from 63.2 to 73.9%). Participants in Mlambe, as compared to those in EUC, had lower rates of heavy alcohol use (89.5% vs. 97.2%) and higher rates of viral suppression (100% vs. 91.9%) at 10-months. Differences between arms were not statistically significant in this small pilot study. Mlambe was highly feasible and acceptable, and shows promise for reducing heavy alcohol use and viral non-suppression among couples with HIV in a larger efficacy study.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Scott Tebbetts
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Conroy AA, Tebbetts S, Darbes LA, Hahn JA, Neilands TB, McKenna SA, Mulauzi N, Mkandawire J, Ssewamala FM. Development of an Economic and Relationship-Strengthening Intervention for Alcohol Drinkers Living with HIV in Malawi. AIDS Behav 2023; 27:2255-2270. [PMID: 36520335 PMCID: PMC9753077 DOI: 10.1007/s10461-022-03956-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Heavy alcohol use among people with HIV in sub-Saharan Africa is driven by household economics such as poverty and unemployment and has negative impacts on couple relationships. Multilevel interventions have the potential to reduce alcohol use and improve relationship outcomes by addressing the web of co-occurring economic, social, and dyadic factors. This objective of this study was to develop an economic and relationship-strengthening intervention for couples in Malawi, consisting of matched savings accounts with financial literacy training and a couples counseling component to build relationship skills. Informed by the ADAPT-ITT framework, we collected multiple rounds of focus group data with key stakeholders and couples to gain input on the concept, session content, and procedures, held team meetings with field staff and an international team of researchers to tailor the intervention to couples in Malawi, and refined the intervention manual and components. The results describe a rigorous adaptation process based on the eight steps of ADAPT-ITT, insights gained from formative data and modifications made, and a description of the final intervention to be evaluated in a pilot randomized clinical trial. The economic and relationship-strengthening intervention shows great promise of being feasible, acceptable, and efficacious for couples affected by HIV and heavy alcohol use in Malawi.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | - James Mkandawire
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Nguyen DN, Vu HM, Nguyen QN, Nguyen CT, Do HT, Vu TMT, Tran BX, Latkin CA, Ho CSH, Ho RCM. Gaps of Knowledge about HIV and Sexually Transmitted Infections Among Industrial Workers in Northern Vietnam. AIDS Behav 2022; 26:188-195. [PMID: 34302559 DOI: 10.1007/s10461-021-03370-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
Industrial workers are a vulnerable population for HIV and sexually transmitted infections (STIs). This cross-sectional study assessed the general knowledge about sexually transmitted infections (STIs) and HIV transmission risk among 289 industrial workers in Northern Vietnam. Results indicated that most workers could identify common routes of HIV transmissions and were aware of common STIs. However, insufficient knowledge about HIV transmission via anal sex practices, as well as common signs and symptoms of STIs were observed. Gender, marital status, education, locality status and health information sources were associated with the knowledge. This study reveals a gap of knowledge about HIV and other STIs, and suggested further tailored education interventions to improve the knowledge and promote sexual health-seeking behaviors in industrial workers.
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Correlates of Self-Reported HIV Testing Among Patients in Specialized Substance Abuse Treatment Centers in South Africa. AIDS Behav 2021; 25:2755-2766. [PMID: 33950340 DOI: 10.1007/s10461-021-03178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 10/21/2022]
Abstract
Substance use is a recognized risk factor for HIV acquisition, transmission and progression in South Africa. Persons who use drugs (PWUD) and access specialist substance abuse treatment centers (SSATCs) are a potentially critical target group for HIV services because of the severity of their substance use and associated health risks. SSATCs represent an opportunity for integrated programming, particularly HIV testing services (HTS), to reach PWUD who are at an increased risk of or living with HIV. This analysis of national SSATC admission data explores self-reported HIV testing and associated factors to identify coverage gaps and integration opportunities. The South African Community Epidemiology Network on Drug Use (SACENDU) collects routine surveillance data to monitor national treatment admission trends in alcohol and other drug use. SACENDU data from 2012 to 2017 was analyzed using chi-square test of independence and logistic regression to examine associations between HTS, demographic characteristics and substances of use. Of 87,339 treatment admissions, 47.5% (n = 41,481) of patients had not accessed HTS in the prior 12 months. HTS was reported less frequently by patients whose primary substance of use was cannabis or those with polysubstance use (36.9% and 41.1%, respectively). None of the substance use sub-groups reported a testing rate above 70%. Compared to specific reference groups, logistic regression showed those with lower odds of HTS were: 15-19 years (OR = 0.59); had primary-level education (OR = 0.51); were scholars/learners (OR = 0.27); and primarily cannabis users (OR = 0.64). Patients whose primary drug was heroin had higher odds of testing (OR = 2.45) as did those who injected drugs (OR = 2.86). Given the low coverage and decreased odds of self-reported HTS among sub-groups of patients in SSATCs, the integration of HIV services for PWUD should be a priority in South Africa and a focus of the national HIV strategy.
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Gichane MW, Wechsberg WM, Ndirangu J, Browne FA, Bonner CP, Grimwood A, Shaikh N, Howard B, Zule WA. Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa. Drug Alcohol Depend 2020; 215:108206. [PMID: 32771909 PMCID: PMC7502463 DOI: 10.1016/j.drugalcdep.2020.108206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND South Africa has the highest HIV prevalence globally, which disproportionately affects women. Hazardous alcohol use reduces antiretroviral adherence which can lead to adverse health. Few evidence-based interventions addressing hazardous alcohol use and HIV have been implemented in real-world settings. This study aimed to evaluate implementation outcomes from the Women's Health CoOp (WHC)-an evidence-based gender-focused HIV intervention-which was implemented in Cape Town. METHODS We conducted this implementation science trial using a modified stepped-wedge design. Four health clinics were paired with four substance use rehabilitation programs and randomized into four cycles. Women living with HIV and who use alcohol or other drugs were recruited into each cycle (n = 120 each cycle). We assessed adoption, acceptability, appropriateness, cost, and fidelity using a mixed methods approach. RESULTS Adoption: 100 % of staff trained in the WHC and designated as interventionists delivered one or more workshops. Acceptability: Interventionists found the WHC content beneficial to their patients and the WHC improved connections between clinical units in facilities. Appropriateness: The WHC aligned with facility goals to improve antiretroviral adherence and reduce alcohol use; however, there were implementation challenges, including staff shortages, stigma, and few places to refer women for supportive services. Cost: The cost of implementing the WHC was 20.59 ZAR (1.40 USD) per attendee. Fidelity: Interventionists implemented the WHC with high fidelity and quality. CONCLUSIONS The findings suggest it is feasible to integrate the WHC into usual-care settings. Future efforts to scale up the intervention will need to address social and structural implementation challenges. TRIAL REGISTRATION NCT02733003 approved 1/21/2016.
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Affiliation(s)
- Margaret W Gichane
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Wendee M Wechsberg
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC, 27599, USA; Department of Psychology, North Carolina State University, 2310 Katharine Stinson Drive Raleigh, Raleigh, NC, 27607, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Jacqueline Ndirangu
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Felicia A Browne
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445, Chapel Hill, NC, 27599, USA
| | | | - Ashraf Grimwood
- Kheth'Impilo AIDS Free Living, 11th Floor, Metlife Centre, 7 Walter Sisulu Avenue, Cape Town, 8000, South Africa
| | - Najma Shaikh
- Kheth'Impilo AIDS Free Living, 11th Floor, Metlife Centre, 7 Walter Sisulu Avenue, Cape Town, 8000, South Africa
| | - Brittni Howard
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - William A Zule
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Chen D, Luo G, Meng X, Wang Z, Cao B, Yuan T, Xie Y, Hu T, Chen Y, Ke W, Wang Z, Sun C, Deng K, Cai Y, Zhang K, Zou H. Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review. BMC Public Health 2020; 20:1310. [PMID: 32859178 PMCID: PMC7455896 DOI: 10.1186/s12889-020-09333-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background Factory workers in low- and middle-income countries (LMICs) are vulnerable to HIV transmission. Interventions are needed to prevent HIV in this population. We systematically reviewed published literature on the efficacy of various HIV interventions in reducing stigma, risk behaviors and HIV transmission among factory workers. Methods A systematic review was performed using predefined inclusion and exclusion criteria. Four databases (PubMed, PsycINFO, Scopus and EMBASE) were searched for relevant publications between January 1, 1990 and December 31, 2018. Two independent reviewers assessed the methodological quality of studies. Results Thirteen articles were included, with 2 randomized controlled trials and 11 cohort studies. Five interventions and their combinations were summarized. Educational intervention increased condom use and reduced the use of recreational drugs and alcohol before sex. Community intervention that proactively provide HIV counselling and testing (HCT) services could increase the detection rate of HIV and other sexually transmitted diseases (STDs). Lottery intervention increased HCT uptake and decreased HIV public stigma. Education combined with community intervention reduced the proportion of workers with casual sex and enhanced HIV knowledge. Peer education combined with community intervention increased the proportion of workers who were willing to take their partners to HCT. Policy intervention combined with peer education enhanced HIV knowledge, perceived condom accessibility and condom use with regular partners. Conclusions Various interventions improved HIV knowledge, decreased HIV stigma and reduced HIV-related risk behaviors among factory workers in LMICs. The combination of multiple interventions tended to achieve better efficacy than a single intervention. Persistent combination interventions are essential to address HIV in this population.
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Affiliation(s)
- Dahui Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, PR China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, Guangdong, PR China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Yu Xie
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Tian Hu
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Yaqi Chen
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Wujian Ke
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Caijun Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China
| | - Kai Deng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Yong Cai
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Kechun Zhang
- Longhua District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, PR China. .,Kirby Institute, University of New South Wales, Sydney, Australia.
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Bitty-Anderson AM, Gbeasor-Komlanvi FA, Johnson P, Sewu EK, Dagnra CA, Salou M, Blatome TJ, Jaquet A, Coffie PA, Ekouevi DK. Prevalence and correlates of alcohol and tobacco use among key populations in Togo in 2017: a cross-sectional study. BMJ Open 2019; 9:e028934. [PMID: 31685493 PMCID: PMC6858156 DOI: 10.1136/bmjopen-2019-028934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The aim of this study was to estimate alcohol and tobacco use prevalence and their correlates among female sex workers (FSW), men who have sex with men (MSM) and drug users (DU) in Togo. DESIGN, SETTING AND PARTICIPANTS A cross-sectional bio-behavioural study was conducted among 2115 MSM, FSW and DU in 2017 using a respondent-driven sampling method, in the eight biggest towns of Togo. Selection criteria for the MSM were being male and having had oral or anal intercourse with a man in the previous 12 months; for FSW, being a female and having exchanged sex for money in the previous 12 months; and for DU, consuming heroin, cocaine or hashish for MSM, FSW and DU, respectively. All participants had to be at least 18 years old and residing in the territory for the past 3 months. RESULTS The prevalence of alcohol consumption, hazardous/harmful consumption and binge drinking was 64.8%, 38.4% and 45.5%, respectively. Current tobacco use was reported by 30.6% of participants and HIV prevalence was estimated at 12.5%. DU were more likely to engage in binge drinking compared with other key populations (adjusted odds ratio (aOR)=2.0; 95% CI 1.4 to 2.8; p=0.001). Participants who were identified as having hazardous/harmful alcohol consumption had almost three times the odds of tobacco consumption than those with no risky consumption (aOR=2.6; 95% CI 2.0 to 3.4; p=0.001). Hazardous/harmful alcohol consumption was three times more likely among participants with severe psychological distress compared with those with no psychological distress (aOR=3.3, 95% CI 2.2 to 5.1; p=0.001). CONCLUSION Findings from this study demonstrate the need for the integration of mental health and substance abuse reduction interventions into HIV prevention programme, particularly those geared towards key populations.
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Affiliation(s)
| | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Department of Public Health, Faculty of Health Sciences, University of Lomé, Lomé, Togo
- Centre Africain de Recherches en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Pascal Johnson
- Centre Africain de Recherches en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Essèboè K Sewu
- Centre Africain de Recherches en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Claver A Dagnra
- Faculty of Health Sciences, Molecular Biology Laboratory, University of Lomé, Lomé, Togo
| | - Mounerou Salou
- Faculty of Health Sciences, Molecular Biology Laboratory, University of Lomé, Lomé, Togo
| | - Tetouyaba J Blatome
- Centre Africain de Recherches en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Antoine Jaquet
- Department of Public Health, INSERM U1219, Bordeaux Population Health Research, University of Bordeaux, Bordeaux, France
- Department of Public Health, Institut de Santé Publique Epidémiologie et Développement, University of Bordeaux, Bordeaux, France
| | - Patrick Ahuatchi Coffie
- PACCI Research Center-Site ANRS Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Department of Public Health, Institut de Santé Publique Epidémiologie et Développement, University of Bordeaux, Bordeaux, France
- Dermatologie et Infectiologie, Unite de Formation et de Recherche des Sciences Medicales, Universite Felix Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - Didier Koumavi Ekouevi
- PACCI Research Center-Site ANRS Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Department of Public Health, Faculty of Health Sciences, University of Lomé, Lomé, Togo
- Centre Africain de Recherches en Epidemiologie et en Santé Publique (CARESP), Lomé, Togo
- Department of Public Health, INSERM U1219, Bordeaux Population Health Research, University of Bordeaux, Bordeaux, France
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Mulqueeny DM, Taylor M. Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2019; 11:e1-e11. [PMID: 30843416 PMCID: PMC6407438 DOI: 10.4102/phcfm.v11i1.1824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 01/26/2023] Open
Abstract
Background Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care. Aim This study investigated whether patients’ needs were being met, described which needs were met, which were not and how such needs could be met. Setting The study took place at four ART clinics in eThekwini district public hospitals. Methods This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients’ needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers’ observations. Results All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution. Conclusion To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes ‘patients’ needs’. The results reflect patients’ willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs.
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Mathews C, Kalichman MO, Laubscher R, Hutchison C, Nkoko K, Lurie M, Kalichman SC. Sexual relationships, intimate partner violence and STI partner notification in Cape Town, South Africa: an observational study. Sex Transm Infect 2017; 94:144-150. [PMID: 29191815 PMCID: PMC5870461 DOI: 10.1136/sextrans-2017-053434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/11/2017] [Indexed: 11/10/2022] Open
Abstract
Objectives We aimed to identify individual and sexual partnership characteristics associated with partner notification (PN) among people with STI. We hypothesised that PN would be less likely in more casual sexual partnerships and in partnerships with intimate partner violence (IPV). Methods We conducted an observational study among the first 330 patients with STI enrolled in a trial of a behavioural intervention to reduce STI incidence, at a clinic in a poor, Cape Town community. We included 195 index patients (those reporting STI symptoms), and conducted longitudinal analyses using participant-completed questionnaires on the day of diagnosis and 2 weeks later. Using partnership data for five recent sexual partners, we assessed factors associated with reported PN with logistic regressions, adjusting for repeated measurements on the same participant for each partner. Results The sample included 99 males with 303 partners and 96 females with 158 partners. Males reported perpetrating IPV in 46.2% of partnerships. Females reported being IPV victims in 53.2% of partnerships. Males notified 58.1%, females 75.4% of partners during the 2 weeks following diagnosis. Type of partner was an independent correlate of PN for males and females, with the odds of PN lower in more casual partnerships. For males, reporting physical IPV perpetration in the partnership was an independent correlate of PN. For females, there was no association between IPV victimisation in a partnership and PN. Conclusions Efforts to decrease the pool of infectious partners need to have a strong focus on the promotion of PN in casual relationships and one-night stands. IPV was not identified as a barrier to PN. In future, we need to investigate the association between IPV with an objective measure of PN success such as partner testing or treatment, or index patient reinfection. Clinical trial registration PACTR201606001682364; Pre-results.
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Affiliation(s)
- Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Cameron Hutchison
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Koena Nkoko
- City of Cape Town Health Department, Cape Town, South Africa
| | - Mark Lurie
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
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Howard BN, Van Dorn R, Myers BJ, Zule WA, Browne FA, Carney T, Wechsberg WM. Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African health services. BMC Health Serv Res 2017; 17:746. [PMID: 29157230 PMCID: PMC5697075 DOI: 10.1186/s12913-017-2669-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Since the beginning of the HIV epidemic, numerous behavior change, risk-reduction, and biomedical interventions have been developed and tested. While some of these interventions have shown to be efficacious in randomized trials, it often takes almost two decades for an intervention to be translated into practice. Meanwhile, South Africa continues to have among the highest prevalence of HIV globally, with women of childbearing age bearing the burden of the epidemic. Given the urgency of the HIV epidemic among vulnerable women in South Africa, it is imperative that evidence-based interventions be implemented rapidly into practice. This study presents a first step toward examining the acceptability and feasibility of implementing the Women's Health CoOp (WHC) in clinics and substance abuse rehab settings in Cape Town, South Africa. METHODS We conducted focus group discussions with women who use substances and with service providers, we also conducted in-depth interviews with health service planners. Our goal was to examine implementation and clinical outcomes associated with delivery of the WHC across clinics and substance abuse rehab programs. RESULTS All participants agreed on the need for the WHC. Perceived facilitators to implementing the WHC included the recognizable need for programs to empower women and to build the capacity of staff to address issues of substance use, sexual risk, and intimate partner violence. Participants also identified potential barriers to women engaging with this program, including the stigma women experience when seeking services and the lack of person-centered care at healthcare facilities. CONCLUSIONS In a country with the largest number of women of childbearing age living with HIV, an evidence-based woman-focused intervention that comprehensively addresses women's risk for suboptimal antiretroviral adherence may be essential for reducing HIV incidence. However, potential barriers to implementing the WHC successfully must be addressed before the program can be fully integrated into the services delivered by healthcare facilities. TRIAL REGISTRATION Clinical trials NCT02733003 . Date of Registration: January 21, 2016, registered retroactively after participant enrollment.
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Affiliation(s)
- Brittni N. Howard
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Richard Van Dorn
- Behavioral and Urban Health Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Bronwyn J. Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town 7505 South Africa
| | - William A. Zule
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Felicia A. Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, Cape Town 7505 South Africa
| | - Wendee M. Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194 USA
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11
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Ogedengbe OO, Naidu ECS, Azu OO. Antiretroviral Therapy and Alcohol Interactions: X-raying Testicular and Seminal Parameters Under the HAART Era. Eur J Drug Metab Pharmacokinet 2017; 43:121-135. [DOI: 10.1007/s13318-017-0438-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Conroy AA, McKenna SA, Leddy A, Johnson MO, Ngubane T, Darbes LA, van Rooyen H. "If She is Drunk, I Don't Want Her to Take it": Partner Beliefs and Influence on Use of Alcohol and Antiretroviral Therapy in South African Couples. AIDS Behav 2017; 21:1885-1891. [PMID: 28150121 PMCID: PMC5493498 DOI: 10.1007/s10461-017-1697-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alcohol consumption and beliefs about mixing alcohol and ART are associated with decreased adherence to antiretroviral therapy (ART). In this study, we examined how romantic partners influence alcohol and ART use. We conducted semi-structured interviews with 24 HIV-positive individuals and their primary partners (48 individuals) in KwaZulu-Natal, South Africa. Almost 17% of participants spontaneously expressed beliefs that alcohol and ART should not be mixed. Participants who held these beliefs influenced their partners' behaviors by either discouraging the mixing of alcohol and ART, which sometimes resulted in missed pills when drinking, or by helping partners manage their medications when drinking. Other participants encouraged partners to take ART no matter what. Messages on alcohol and ART may need to be refined for ART patients who cannot abstain from alcohol. Primary partners should be included in these education efforts and their influence could be leveraged to help reduce alcohol consumption and maintain adherence.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA.
| | | | - Anna Leddy
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MI, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
| | - Thulani Ngubane
- Human Sciences Research Council, Human and Social Development Programme, Durban, South Africa
| | - Lynae A Darbes
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street 3rd Floor, San Francisco, CA, USA
- Department of Health Behavior and Biological Sciences, and Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Heidi van Rooyen
- Human Sciences Research Council, Human and Social Development Programme, Durban, South Africa
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13
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Madhombiro M, Dube-Marimbe B, Dube M, Chibanda D, Zunza M, Rusakaniko S, Stewart D, Seedat S. A cluster randomised controlled trial protocol of an adapted intervention for alcohol use disorders in people living with HIV and AIDS: impact on alcohol use, general functional ability, quality of life and adherence to HAART. BMC Psychiatry 2017; 17:44. [PMID: 28129756 PMCID: PMC5273845 DOI: 10.1186/s12888-017-1208-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/17/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interventions for alcohol use disorders (AUDs) in HIV infected individuals have been primarily targeted at HIV risk reduction and improved antiretroviral treatment adherence. However, reduction in alcohol use is an important goal. Alcohol use affects other key factors that may influence treatment course and outcome. In this study the authors aim to administer an adapted intervention for AUDs to reduce alcohol use in people living with HIV/AIDS (PLWHA). METHODS This study is a cluster randomised controlled trial at 16 HIV care clinics. A motivational interviewing and cognitive behavioural therapy based intervention for AUDs, developed through adaptation and piloted in Zimbabwe, will be administered to PLWHA with AUDs recruited at HIV clinics. The intervention will be administered over 16 sessions at 8 HIV clinics. This intervention will be compared with an equal attention control in the form of the World Health Organization Mental Health Gap Action Programme (WHO mhGAP) guide, adapted for the Zimbabwean context. General function, quality of life, and adherence to highly active antiretroviral treatment (HAART) will be secondary outcomes. Booster sessions will be administered to both groups at 3 and 6 months respectively. The primary outcome measure will be the Alcohol Use Disorder Identification Test (AUDIT) score. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), World Health Organisation Quality of Life (WHOQoL) HIV, viral load, and CD4 counts will be secondary outcome measures. Outcome assessments will be administered at baseline, 3, 6, and 12 months. Moderating factors such as perceived social support, how people cope with difficult situations and post-traumatic exposure and experience will be assessed at baseline. Trained research assistants will recruit participants. The outcome assessors who will be trained in administering the outcome and moderating tools will be blinded to the treatment arms allocated to the participants. However, the principal investigator, participants and intervention staff will be unblinded. Data will be analysed using STATA Version 14. Primary and secondary outcomes will be measured at four time points that is; at baseline, 3, 6, and 12 months respectively. All participants will be included in the analysis of primary and secondary outcome measures. The mean AUDIT scores will be compared between groups using student t-tests. Multilevel logistic regression analysis will be performed for binominal variables and multilevel linear regression for continuous variables. Descriptive statistics will be computed for baseline and follow-up assessments. DISCUSSION The study will be the first to address problematic alcohol use in PLWHA in Zimbabwe. It seeks to use local resources in delivering a modified, brief, evidence-based, and culturally contextualised intervention. The study results will determine the effectiveness of adapting psychological interventions for AUDs in HIV infected adults using a task-sharing framework. TRIAL REGISTRATION Pan African Clinical Trial Registry, PACTR201509001211149 . Registered 22 July 2015.
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare, Zimbabwe. .,Harare Central Hospital, Psychiatric Unit, Southerton, Harare, Zimbabwe.
| | - Bazondlile Dube-Marimbe
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Michelle Dube
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - Dixon Chibanda
- 0000 0004 0572 0760grid.13001.33Department of Psychiatry, Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe ,Harare Central Hospital, Psychiatric Unit, Southerton, Harare Zimbabwe
| | - Moleen Zunza
- 0000 0001 2214 904Xgrid.11956.3aStellenbosch University, Faculty of Medicine and Health Sciences, Biostatistics Unit, Tygerberg Campus, Parow, Cape Town, South Africa
| | - Simbarashe Rusakaniko
- 0000 0004 0572 0760grid.13001.33Department of Community Medicine Parirenyatwa Group of Hospitals, University of Zimbabwe, College of Health Sciences, Mazowe Street, Box A178, Avondale, Harare Zimbabwe
| | - David Stewart
- Department of Psychology, Seattle Pacific University, 3rd Avenue W Seattle 206-281-2000, Washington, 3307 USA
| | - Soraya Seedat
- 0000 0001 2214 904Xgrid.11956.3aDepartment of Psychiatry, Stellenbosch University, Faculty of Medicine and Health Sciences, Tygerberg Campus, Parow, Cape Town, South Africa
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14
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Thakarar K, Asiimwe SB, Cheng DM, Forman L, Ngabirano C, Muyindike WR, Emenyonu NI, Samet JH, Hahn JA. Alcohol Consumption in Ugandan HIV-Infected Household-Brewers Versus Non-Brewers. AIDS Behav 2016; 20:2408-2417. [PMID: 27150894 PMCID: PMC5025349 DOI: 10.1007/s10461-016-1421-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The brewing of alcohol in Ugandan households is common, yet little is known about its relationship with alcohol consumption in HIV-infected individuals. We performed a cross-sectional analysis to assess the association between household brewing and unhealthy alcohol consumption among 387 HIV-infected adults in a prospective study examining the association between alcohol consumption and HIV-disease progression. Household brewing was defined as participants reporting that they or a household member home-brewed alcohol. Logistic regression was used to assess the association between household brewing and unhealthy alcohol consumption, defined as phosphatidylethanol (PEth) level ≥50 ng/ml or AUDIT-C (modified to measure the prior 3 months) positive. Sixty-six (17.0 %) participants reported household brewing. Household brewers had higher odds of unhealthy alcohol consumption (AOR 2.27, 95 % CI 1.26-4.12). Among HIV-infected individuals, household brewing was associated with unhealthy alcohol consumption. Interventions to reduce alcohol consumption in this population could target household brewers.
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Affiliation(s)
- Kinna Thakarar
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
| | - Stephen B Asiimwe
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Debbie M Cheng
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Leah Forman
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | | | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
- School of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, USA
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15
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Myers B, Sorsdahl K, Morojele NK, Kekwaletswe C, Shuper PA, Parry CDH. "In this thing I have everything I need": perceived acceptability of a brief alcohol-focused intervention for people living with HIV. AIDS Care 2016; 29:209-213. [PMID: 27435957 DOI: 10.1080/09540121.2016.1211242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although hazardous/harmful alcohol use impacts response to HIV treatment, there have been few attempts to deliver alcohol-reduction interventions within South African HIV treatment services. As a first step towards implementing alcohol-focused interventions in these settings, we explored patients' views of the acceptability of a brief motivational interviewing and problem-solving intervention. In-depth interviews were conducted with 11 patients recruited from three HIV treatment sites in Tshwane, South Africa, who had completed the intervention. Participants noted that the intervention was acceptable and appropriate. As a result of the intervention, participants reported less use of alcohol as a coping mechanism. They described greater use of problem-focused and emotional coping strategies for dealing with mutable and immutable problems, respectively. Their only recommendation for improving the intervention was the addition of booster sessions. Findings suggest that this intervention is acceptable to patients receiving HIV treatment and is perceived to be helpful for reducing their use of alcohol.
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Affiliation(s)
- Bronwyn Myers
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Katherine Sorsdahl
- c Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Neo K Morojele
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,d School of Public Health , University of the Witwatersrand , Witwatersrand , South Africa.,e School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Connie Kekwaletswe
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa
| | - Paul A Shuper
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,f Social and Epidemiological Research Department , Centre for Addiction and Mental Health , Toronto , ON , Canada.,g Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Charles D H Parry
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,h Department of Psychiatry , Stellenbosch University , Stellenbosch , South Africa
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16
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Teshome W, Belayneh M, Moges M, Endriyas M, Mekonnen E, Ayele S, Misganaw T, Shiferaw M, Chinnakali P, Hinderaker SG, Kumar AMV. Who takes the medicine? Adherence to antiretroviral therapy in Southern Ethiopia. Patient Prefer Adherence 2015; 9:1531-7. [PMID: 26604706 PMCID: PMC4631418 DOI: 10.2147/ppa.s90816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Treatment adherence is critical for the success of antiretroviral therapy (ART) for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it in 20 randomly selected ART clinics of Southern Ethiopia. METHODS In this cross-sectional study, we interviewed consecutive HIV patients on first-line antiretroviral regimen attending the clinics in June 2014 using a pretested and structured questionnaire. For measuring adherence, we used 4-day recall method based on "The AIDS Clinical Trial Group adherence assessment tool". Patients were classified as "Incomplete adherence" if they missed any of the doses in the last 4 days. Data were singly entered using EpiData and descriptive analysis, and unadjusted odds ratios were calculated using EpiDataStat software. Multivariate logistic regression analysis was performed using Stata v12.0. RESULTS Of 974 patients interviewed, 539 (56%) were females, and mean age was 35 years. The proportion of patients with incomplete adherence was 13% (95% confidence interval: 11%-15%). In multivariate analysis, factors significantly associated with incomplete adherence included young age, being Protestant Christian, consuming alcohol, being single, and being a member of an HIV association. Psychosocial factors like stigma, depression, and satisfaction to care were not associated with incomplete adherence in the current context. CONCLUSION The overall adherence to ART was good. However, there were certain subgroups with incomplete adherence who need special attention. The health care providers (especially counselors) need to be aware of these subgroups and tailor their counseling to improve adherence among these groups. Exploratory qualitative studies may help uncover the exact reasons for incomplete adherence.
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Affiliation(s)
- Wondu Teshome
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Wondu Teshome, PO Box 898, Hawassa, Ethiopia, Tel +251 91 176 1805, Email
| | - Mihretu Belayneh
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mathewos Moges
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Misganu Endriyas
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Emebet Mekonnen
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Sinafiksh Ayele
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Tebeje Misganaw
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Mekonnen Shiferaw
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | | | - Ajay MV Kumar
- The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
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