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Cited by 14Health Policy Implementation ScienceHIV/AIDS Research and InterventionsHIV, Drug Use, Sexual Risk

Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa

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Gichane, Margaret W., Wechsberg, Wendee M., Ndirangu, Jacqueline, Browne, Felicia A., Bonner, Courtney Peasant, Grimwood, Ashraf, Shaikh, Najma, Howard, Brittni +1 more·2020·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2020.108206PMC PMC7502463
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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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Authors
Gichane, M. W., Wechsberg, W. M., Ndirangu, J., Browne, F. A., Bonner, C. P., Grimwood, A., Shaikh, N., Howard, B., & Zule, W. A.
Affiliations
  • RTI International (US)
  • University of North Carolina at Chapel Hill (US)
  • Kheth’Impilo (ZA)
Corresponding author
Wechsberg, Wendee M.
ORCID
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2020-10
Volume
215
Pages
108206
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2020.108206
PMC
PMC7502463
OpenAlex
W3046675917
Cited by
14
References
4
Citations by year
2026: 2 · 2025: 2 · 2023: 1 · 2022: 5 · 2021: 4
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
HIV, hazardous drinking, women living with HIV, implementation outcomes, antiretroviral therapy adherence, addiction rehabilitation, intervention fidelity, acceptability, cost, South Africa
MeSH terms
Implementation Science, Adult, Alcohol Drinking, Ethanol, Female, Humans, Male, South Africa, HIV Infections, Women's Health, Risk Reduction Behavior, Social Stigma

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