This study was funded by NICHD grant number R01HD058320
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Transcript of This study was funded by NICHD grant number R01HD058320
Results of a Brief Intervention for Reducing Alcohol Use among HIV
Positive Women in Cape Town, South Africa
This study was funded by NICHD grant number R01HD058320
William Zule,1 Irene Doherty,1Bronwyn Meyers,2 Felicia Browne,3 Tara Carney,2 Charles Parry,2 Wendee Wechsberg1
1RTI International, Research Triangle Park, NC, USA2Medical Research Council, Cape Town, South Africa3Harvard University School of Public Health, Cambridge, MA, USA
Background
Alcohol use is linked to sex risk behaviors
Alcohol use may decrease adherence to antiretroviral therapy
In models “HIV treatment as prevention” has the potential for ending the HIV epidemic
Interventions to reduce alcohol use among people living with HIV are essential to this effort
EBI Women’s CoOp Adaptations
N.C., U.S. (1998 – present)
Women’s CoOp 1, 2 and Pregnant Women’s CoOp
Young Women’s CoOp
NIDA and CDC
Cape Town , SA (2003 – present)
NIDA, NICHD and NIAAA
Pretoria, SA (2001 – 2008)
(2011 to present)
Sex workers and vulnerable women
NIDA and NIAAA
St. Petersburg, Russia (2006 – 2009)
Republic of Georgia (2010 to present)
IDU Women
NIDA
Outreach Efforts Weighted Across 15 Townships and Communities
Cape Town in the Western
Cape Province
Theoretical bases Black feminist theory; empowerment theory
Key intervention characteristics and core elements
woman-focused cue cards; role-playing and rehearsal, including condom demonstration and practice; individualized risk assessment and action plan; and active referrals to community resources
Target Population female substance-using women from Cape Town communities
Delivery methods
In person
Deliverers South African women (Black and Colored) who were trained to deliver the intervention
Unit of delivery 2 group sessions
Goal: Decrease sexual risk, AOD use and violence in women’s lives
Overview of Women’s Health CoOp Intervention
Eligibility Criteria for Main Study
female
age 18–33 years
used at least two drugs (one of which could be alcohol) at least once a week for the past 3 months
sexually active with a man in the past month
living in one of the target communities,
Demographic Information (Baseline)
Women’s CoOp
Comparison Arms
Age [M(SD)] 22.3 (4.1) 23.8 (4.3)
Have Main Partner 100% 92%
≤ Grade 11 83% 94%
Ever Physically Abused
36% 83%
Ever Raped 12% 32%
HIV + (confirmatory) 37% 7%
Enrollment Women’s :
360Nutrition :
181VCT only :
179
Main Study Participant Characteristics (N=720)
12M Follow-Up Rate 83%
Main Study Drug Use by Intervention Arm Baseline
Biological Drug Test Results at Baseline
Women’s Arm
N= 324
Comparison Arms
N = 396
Methamphetamine (Tik) # 45% 49%
Mandrax # 29% 21%
Opiates * 8% 6%
I
• HIV positive• Self-report of alcohol use at baseline
Additional Criteria for Inclusion in Current Analyses (n = 84)
Abstinence from Alcohol at 12-month Followup by Intervention Arm
Baseline 12-month followup0
10
20
30
40
50
60
70
80
90
100
0
46
0
18
WHCComparison
% a
bst
inen
t fr
om
alc
oh
ol
Logistic regressions model for abstinence from alcohol at 12-month followupa
Coefficient Odds ratio (95% C.I.) p-value
1.28 3.61 (1.23- 11.70) 0.016
aAdjusted for level of alcohol use at baseline
Abstinence from Alcohol at 12-month Followup
Negative Urine Drug Screen Results for Opiates, Cocaine, Methamphetamine and Methaqualone by Intervention Arm
Baseline 12-month followup0
10
20
30
40
50
60
70
80
90
100
52
63
52 52 WHCComparison
% n
egat
ive
uri
ne
dru
g s
cree
n
Logistic regression of negative test results for opiates, cocaine, methamphetamine, and methaqualone
Coefficient Odds ratio (95% C.I.) p-value
1.12 3.07 (0.83-12.31) 0.105
badjusted for number of drugs positive for at baseline
Model of Drug Use Outcomes at 12-month Followup
• In previous analyses of the whole sample, this intervention was efficacious in increasing abstinence from AOD (Wechsberg et al., 2013).
• In subgroup analyses of HIV positive drinkers the intervention was efficacious in increasing abstinence from alcohol.
Conclusions
Wechsberg, W.M., et al. "A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women’s Health CoOp." BMJ Open 3.5 (2013)
• HIV “treatment as prevention” requires achieving high levels of retention and medication adherence among high risk populations living with HIV
• As we engage more high risk populations, comorbid AOD use will become a critical barrier to retention and adherence that may prevent “treatment as prevention” from fulfilling its promise.
Implications