A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya
Open accessAbstract
Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub‐Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive–behavioral therapy (CBT) intervention to reduce alcohol use among HIV‐infected outpatients in Eldoret, Kenya. Design: Randomized clinical trial. Setting: A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration. Participants: A total of 614 HIV‐infected outpatients [312 CBT; 302 healthy life‐styles (HL); 48.5% male; mean age: 38.9 years; mean education 7.7 years] who reported a minimum of hazardous or binge drinking. Intervention and comparator: A culturally adapted six‐session gender‐stratified group CBT intervention compared with HL education, each delivered by paraprofessionals over six weekly 90‐minute sessions with a 9‐month follow‐up. Measurements: Primary outcome measures were percentage of drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the time‐line follow‐back from baseline to 9 months post‐intervention. Exploratory analyses examined unprotected sex and number of partners. Findings: Median attendance was six sessions across condition. Retention at 9 months post‐intervention was high and similar by condition: CBT 86% and HL 83%. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period, PDD – CBT = 3.64 (0.696), HL = 5.72 (0.71), mean difference 2.08, 95% confidence interval (CI) = 0.13 – 4.04; DDD – CBT = 0.66 (0.96), HL = 0.98 (0.098), mean difference = 0.31, 95% CI = 0.05 – 0.58. Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1‐month follow‐up. Conclusions: A cognitive–behavioral therapy intervention was more efficacious than healthy lifestyles education in reducing alcohol use among HIV‐infected Kenyan outpatient drinkers.
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Randomization to receive CBT, in different modalities, was associated with a higher reduction in drinking days, drinks per drinking days, and AUDIT score compared to usual care.
“Randomization to receive CBT, in different modalities, was found to be associated with a higher reduction in drinking days, drinks per drinking days [77,78], and AUDIT score [63] in comparison to usual care”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [78]
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“Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub-Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder.”
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“Background and aims: Culturally relevant and feasible interventions are needed to address limited professional resources in sub-Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder.”
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“Indeed, the cost-effectiveness of our paraprofessional delivery method has been confirmed in several simulation modeling papers based on our pilot study data (62-64).”
MethodTargeting an Alcohol Intervention Cost‐Effectively to Persons Living with HIV / AIDS in East Africa
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“Indeed, the cost-effectiveness of our paraprofessional delivery method has been confirmed in several simulation modeling papers based on our pilot study data (62-64).”
Method
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“…may increase social trust may include trust-building exercises (Rhodes et al., 2020; Sseguya et al., 2018), group cognitive behavioural therapy (Papas et al., 2020), targeted training for community health workers on how to develop trusting relationships with the community (Dawson-Rose et al.,…”
BackgroundPurgato, M., Prina, E., Ceccarelli, C., Cadorin, C., Abdulmalik, J. O., Amaddeo, F., Arcari, L., Churchill, R., Jordans, M. J., Lund, C., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014722.pub2 · Cited by 27 · see citing works
Parry, C. D. H., Myers, B., Londani, M., Shuper, P. A., Janse van Rensburg, C., Manda, S. O. M., Nkosi, S., Kekwaletswe, C. T., Hahn, J. A., Rehm, J., et al. (2023) · Addiction · doi:10.1111/add.16278 · Cited by 22 · see citing works
“In the two studies conducted in Kenya, six sessions of cognitive behavioural therapy significantly reduced alcohol use compared with TAU [23] or a healthy life-style alternative [24].”
BackgroundConroy, A. A., Tebbetts, S., Darbes, L. A., Hahn, J. A., Neilands, T. B., McKenna, S. A., Mulauzi, N., Mkandawire, J., & Ssewamala, F. M. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03956-3 · Cited by 16 · see citing works
Chamie, G., Hahn, J. A., Kekibiina, A., Emenyonu, N. I., Beesiga, B., Marson, K. G., Fatch, R., Lodi, S., Adong, J., Thirumurthy, H., et al. (2023) · The Lancet Global Health · doi:10.1016/s2214-109x(23)00436-9 · Cited by 14 · see citing works
Wechsberg, W. M., van der Drift, I. M., Howard, B. N., MYERS, B. J., Browne, F. A., Bonner, C. P., Carney, T., Ndirangu, J., & Washio, Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148661 · Cited by 13 · see citing works
“Two interventions were grounded in CBT, including one with outpatients living with HIV focused on HIV and alcohol education, alcohol abstinence, coping with substance use triggers, problem solving, and refusal skills [74]; and another with heterosexual couples that used a joint cognitive– behavioral, multi-problem, tr…”
BackgroundMethodInfluentialHassan, A. A., Ibrahim, A. M., & Nadkarni, A. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.111093 · Cited by 13 · see citing works
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“Further, the growing ubiquity of mobile phone usage in SSA [21], and the acceptability of mobile phone-based HIV interventions in Uganda [22], indicates that HWHL could be feasibly implemented in this setting.”
BackgroundInfluentialGreene, M. C., Kane, J., Alto, M., Giusto, A., Lovero, K., Stockton, M., McClendon, J., Nicholson, T., Wainberg, M. L., Johnson, R. M., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013350.pub2 · Cited by 11 · see citing works
Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters
Wechsberg, W. M., Browne, F. A., Bonner, C. P., Washio, Y., Howard, B. N., & van der Drift, I. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00558-x · Cited by 10 · see citing works
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Fuller, T., & Hoare, D. J. (2024) · Springer eBooks · doi:10.1007/978-3-031-35647-6_44 · Cited by 3 · see citing works
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Magnolini, R., Staehelin, S., Senkoro, E., Kruijver, M., Krinke, E., & Weisser, M. (2024) · AIDS Care · doi:10.1080/09540121.2023.2298779 · Cited by 2 · see citing works
Gichane, M. W., Camlin, C. S., Getahun, M., Emenyonu, N., Woolf-King, S., Sanyu, N., Katusiime, A., Fatch, R., Muyindike, W., & Hahn, J. A. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2244066 · Cited by 1 · see citing works
Onohuean, H., Onohuean, F. E., Omara, C., & Saleem, H. T. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1494469 · Cited by 1 · see citing works
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“The attrition rates were based on a prior study testing a substance use intervention in our setting [41,42].”
InfluentialChander, G., Batey, D. S., Austin, E. J., Bentley, M. J., Cachay, E. R., Crane, H. M., Farel, C. E., Fleming, J. G., Grelotti, D. J., Hutton, H. E., et al. (2026) · Addiction Science & Clinical Practice · doi:10.1186/s13722-026-00662-6 · Cited by 1 · see citing works
“Studies among PWH support brief alcohol intervention (computer and person-delivered), motivational interviewing, cognitive behavioral therapy, and pharmacotherapy as effective EBIs for reducing alcohol use [14–21].”
Lasater, M. E., Kanguya, T., Chipungu, J., Kane, J. C., Skavenski, S. V. W., Murray, L. K., Vinikoor, M. J., & Sharma, A. (2023) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100195 · Cited by 1 · see citing works
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“The majority of studies were conducted in the United States, with the remaining two conducted in Kenya [37, 76].”
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Efectividad de la TCC en adultos con trastornos por consumo de sustancias: Revisión sistemática
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Efectividad de la TCC en adultos con trastornos por consumo de sustancias: Revisión sistemática
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Unhealthy Alcohol Use in People Living with HIV: A Narrative Review
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- Authors
- Papas, R. K., Gakinya, B. N., Mwaniki, M. M., Lee, H., Keter, A. K., Martino, S., Klein, D. A., Liu, T., Loxley, M. P., Sidle, J. E., Schlaudt, K., Nafula, T., Omodi, V. M., Baliddawa, J. B., Kinyanjui, D. W., & Maisto, S. A.
- Affiliations
- Brown University (US)
- Moi University (KE)
- AMPATH (KE)
- Yale University (US)
- Right Response LLC Minneapolis MN USA
- Indiana University School of Medicine (US)
- Lutheran World Foundation, Gore Chad
- Syracuse University (US)
- Corresponding author
- Papas, Rebecca K.
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2020-07-13
- Volume
- 116
- Issue
- 2
- Pages
- 305-318
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC7671944
- OpenAlex
- W3027304048
- Cited by
- 37
- References
- 56
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 10 · 2022: 5 · 2021: 4 · 2020: 3
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (2K05 16928, R01AA020805)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- alcohol consumption, HIV infection, cognitive behavioral therapy, group therapy, culturally tailored interventions, paraprofessionals, healthy lifestyle education, dual epidemics, sexual risk behavior, unprotected sex, number of sexual partners, intervention retention, Eldoret, Kenya, sub-Saharan Africa
- MeSH terms
- Adult, Alcohol Drinking, Alcoholism, Female, Humans, Kenya, Male, Middle Aged, Outpatients, HIV Infections, Cognitive Behavioral Therapy, Treatment Outcome
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