Motivational interviewing and problem-solving therapy intervention for patients on antiretroviral therapy for HIV in Tshwane, South Africa : a randomized controlled trial to assess the impact on alcohol consumption

Abstract

DATA AVAILABILITY STATEMENT : The data that support the findings of this study are available from the corresponding author upon reasonable request.SUPPLEMENTARY MATERIAL 1: APPENDIX S1. TABLE S1: List of randomized controlled trials (RCTs) that have evaluated the efficacy of non-specialist health worker-delivered interventions to reduce alcohol use among PLHIV. TABLE S2: Modifications to protocol. TABLE S3: Intervention Package. TABLE S4: Imputed longitudinal GEE models comparing intervention (MI/PST) to control (Overall) for Method 2. TABLE S5: Imputed longitudinal GEE models comparing intervention (MI/PST) to control (Overall) (AUDIT≥8) for Method 2.SUPPLEMENTARY MATERIAL 2 : APPENDIX S2. Supporting Information.BACKGROUND AND AIMS : Reduction of alcohol consumption is important for people undergoing treatment for HIV. We tested the efficacy of a brief intervention for reducing the average volume of alcohol consumed among patients on HIV antiretroviral therapy (ART). DESIGN, SETTING AND PARTICIPANTS : This study used a two-arm multi-centre randomized controlled trial with follow-up to 6 months. Recruitment occurred between May 2016 and October 2017 at six ART clinics at public hospitals in Tshwane, South Africa. Participants were people living with HIV, mean age 40.8 years [standard deviation (SD) = 9.07], 57.5% female, and on average 6.9 years (SD = 3.62) on ART. At baseline (BL), the mean number of drinks consumed over the past 30 days was 25.2 (SD = 38.3). Of 756 eligible patients, 623 were enrolled. INTERVENTION : Participants were randomly assigned to a motivational interviewing (MI)/problem-solving therapy (PST) intervention arm (four modules of MI and PST delivered over two sessions by interventionists) or a treatment as usual (TAU) comparison arm. People assessing outcomes were masked to group assignment. MEASUREMENTS : The primary outcome was the number of standard drinks (15 ml pure alcohol) consumed during the past 30 days assessed at 6-month follow-up (6MFU). FINDINGS : Of the 305 participants randomized to MI/PST, 225 (74%) completed the intervention (all modules). At 6MFU, retention was 88% for the control and 83% for the intervention arm. In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6MFU was −0.410 (95% confidence interval = −0.670 to −0.149) units lower on log scale in the intervention group than in the control group (P = 0.002), a 34% relative reduction in the number of drinks. Sensitivity analyses were undertaken for patients who had alcohol use disorders identification test (AUDIT) scores ≥ 8 at BL (n = 299). Findings were similar to those of the whole sample. CONCLUSIONS : In South Africa, a motivational interviewing/problem-solving therapy intervention significantly reduced drinking levels in HIV-infected patients on antiretroviral therapy at 6-month follow-up.South African Medical Research Council Competitive Flagships Awards Project.http://wileyonlinelibrary.com/journal/addhj2024StatisticsSDG-03:Good heatlh and well-bein