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

Study Design

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