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
Open accessAbstract
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.
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Interventions in the exploratory search utilized varied strategies including cognitive behavioral therapy, problem solving therapy, motivational interviewing, and advice.
“interventions utilized varied strategies including cognitive behavioral therapy [32], problem solving therapy [33]MI [25], and advice [34] either offered alone or in combination.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [33]
In PLWH in South Africa, the decrease in AUDIT-C score was significantly greater at both time-points in the intervention arm.
“The decrease in the AUDIT-C score was significantly greater at both time-points in the intervention arm.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
In PLWH in South Africa, the brief intervention produced a 34% relative reduction in the number of standard drinks consumed over the past 30 days at 6-month follow-up compared to control (intention-to-treat analysis: −0.410 log units, 95% CI −0.670 to −0.149, P = 0.002).
“In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6-month follow-up 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.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
In PLWH in South Africa, participants in the intervention group had lower adjusted log odds of having elevated PEth scores at 3MFU and 6MFU (P < 0.05).
“Participants in the intervention group also had lower adjustedlog odds of having elevated PEth scores at 3MFU and 6MFU, respectively (P < 0.05).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
In PLWH in South Africa, the decrease in total AUDIT scores from baseline to follow-up was significantly greater in the intervention arm than the control arm at both 3MFU and 6MFU (P < 0.05).
“For total AUDIT scores, the decrease from BL to follow-up for the treatment arm was significantly greater than that of the control arm at both 3MFU and 6MFU (P < 0.05)”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
In PLWH in South Africa, the average number of drinks consumed per month at 3-month follow-up was lower on the log scale, indicating a marginally significant reduction from baseline to 3MFU for intervention versus control (P = 0.075).
“The average number of drinks consumed per month at 3MFU was lower on the log scale, indicating a marginally significant reduction from BL to 3MFU for intervention versus control (P = 0.075).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
In PLWH in South Africa, there were no statistically significant intervention effects for adherence to ART or viral load.
“There were no statistically significant intervention effects for adherence to ART or viral load.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [88]
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- Authors
- 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., Sorsdahl, K., & Morojele, N. K.
- Affiliations
- South African Medical Research Council (ZA)
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa and Department of Statistics University of Pretoria Pretoria South Africa
- University of California, San Francisco (US)
- Centre for Addiction and Mental Health (CA)
- University of Cape Town (ZA)
- Corresponding author
- Parry, Charles D. H.
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2023-06-20
- Volume
- 118
- Issue
- 11
- Pages
- 2164-2176
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC10592292
- OpenAlex
- W4381325678
- Cited by
- 22
- References
- 31
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 6 · 2023: 1
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Addiction (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- UpSpace Institutional Repository (University of Pretoria) (submittedVersion, cc-by-nc-nd)
- Funders
- South African Medical Research Council ([SAMRC-RFA-IFSP01-2013/AlcoholHIV], RFA-IFSP-01-2013)
- National Institutes of Health (NIH K24)
- Medical Research Council
- National Institute on Alcohol Abuse and Alcoholism (K24AA022586)
- Fogarty International Center (D43TW012029)
- 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
- motivational interviewing, problem-solving therapy, alcohol consumption, HIV, antiretroviral therapy, brief intervention, alcohol consumption reduction, people living with HIV, alcoholism, treatment retention, AUDIT screening, intervention fidelity, South Africa
- MeSH terms
- Adult, Alcohol Drinking, Alcoholism, Female, Humans, Male, South Africa, HIV Infections, Motivational Interviewing
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