Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya
Open accessAbstract
Aims Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub‐Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six‐session gender‐stratified group cognitive–behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV‐infected out‐patients in Eldoret, Kenya. Design Randomized clinical trial comparing CBT against a usual care assessment‐only control. Setting A large HIV out‐patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration. Participants Seventy‐five HIV‐infected out‐patients who were antiretroviral (ARV)‐initiated or ARV‐eligible and who reported hazardous or binge drinking. Measurements Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method. Findings There were 299 ineligible and 102 eligible out‐patients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30‐day follow‐up were large [d = 0.95, P = 0.0002, mean difference = 24.93, 95% confidence interval (CI): 12.43, 37.43 PDD; d = 0.76, P = 0.002, mean difference = 2.88, 95% CI: 1.05, 4.70 DDD]. Randomized participants attended 93% of the six CBT sessions offered. Reported alcohol abstinence at the 90‐day follow‐up was 69% (CBT) and 38% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college‐educated therapists in the United States. Treatment effect sizes were comparable to alcohol intervention studies conducted in the United States. Conclusions Cognitive–behavioral therapy can be adapted successfully to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV‐infected Kenyan out‐patients.
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For Papas 2011, random sequence generation was judged at unclear risk of bias.
“Random sequence generation (selection bias) Unclear risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
The Methods > Procedures > Randomization section (page unavailable) describes gender-stratified randomization by participants drawing concealed condition papers from a jar. This supports that the paper reports a method of random assignment, but the paper does not assess random sequence generation as being at unclear risk of bias; that is the citing authors’ judgment. (LLM, conf=0.78)
Experimental — accuracy not yet measuredFor Papas 2011, incomplete outcome data was judged at unclear risk of bias.
“Incomplete outcome data (attrition bias) All outcomes Unclear risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
The Methods > Procedures section reports 6% missing observations, and Results > Recruitment, retention and adverse events reports one dropout before treatment. These passages document incomplete data, but the paper does not assign its own attrition-bias rating of “unclear risk”; that rating is the citing authors’ assessment. (LLM, conf=0.78)
Experimental — accuracy not yet measuredFor Papas 2011, allocation concealment was judged at low risk of bias.
“Allocation concealment (selection bias) Low risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
For Papas 2011, blinding of outcome assessment was judged at high risk of bias.
“Blinding of outcome assessment (detection bias) All outcomes High risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
For Papas 2011, blinding of participants and personnel was judged at high risk of bias.
“Blinding of participants and personnel (performance bias) All outcomes High risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
Motivational interviewing and/or cognitive behavioral therapy showed a lower likelihood of retention relative to usual care.
“Individual studies varied between displaying a greater likelihood of retention in home visits and psychotherapy relative to psychotherapy alone (Moraes 2010), but lower likelihood of retention in motivational interviewing and/or cognitive behavioral therapy relative to usual care (Jordans 2019; Papas 2011).”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
The Results section, “Recruitment, retention and adverse events” (page unavailable), reports that CBT participants attended 93% of offered sessions, but gives no retention comparison with usual care. Searches for retention, dropout, and follow-up did not find evidence that CBT participants were less likely to be retained. (LLM, conf=0.72)
Experimental — accuracy not yet measuredFor Papas 2011, selective reporting was judged at unclear risk of bias.
“Selective reporting (reporting bias) Unclear risk”
From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Papas 2011
The Methods describe the trial and its outcome assessments, but do not judge the risk of selective reporting. Searches for selective reporting, prespecified outcomes, and trial registration found no passage establishing an 'unclear risk' rating; that appears to be the citing authors’ assessment. (LLM, conf=0.70)
Experimental — accuracy not yet measuredRandomization 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 [77]
Most commonly, psychotherapy or counseling interventions used MI techniques or cognitive behavioral therapy (CBT).
“Most commonly, interventions used MI techniques [22,23,61,69,72,83] or cognitive behavioral therapy (CBT) [53,64,68,77,78,87].”
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 [77]
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- Authors
- Papas, R. K., Sidle, J. E., Gakinya, B. N., Baliddawa, J. B., Martino, S., Mwaniki, M. M., Songole, R., Omolo, O. E., Kamanda, A. M., Ayuku, D. O., Ojwang, C., Owino‐Ong'or, W. D., Harrington, M., Bryant, K. J., Carroll, K. M., Justice, A. C., Hogan, J. W., & Maisto, S. A.
- Affiliations
- Brown University (US)
- Moi University (KE)
- Yale University (US)
- AMPATH (KE)
- Rhode Island Hospital (US)
- National Institutes of Health (US)
- Syracuse University (US)
- Corresponding author
- Papas, Rebecca K.
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2011-08-18
- Volume
- 106
- Issue
- 12
- Pages
- 2156-2166
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3208780
- OpenAlex
- W1915466192
- Semantic Scholar
- 7ad65f52fffcc2b89a96d8f5257d52d22624531b
- Cited by
- 111
- References
- 51
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 1 · 2023: 9 · 2022: 8 · 2021: 4 · 2020: 16 · 2019: 13 · 2018: 6 · 2017: 12 · 2016: 9 · 2015: 7 · 2014: 9 · 2013: 7 · 2012: 2
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- United States Agency for International Development
- National Institute on Alcohol Abuse and Alcoholism (R21AA016884, RC1AA019186, P01AA019072)
- National Institute on Drug Abuse (P50DA009241, P50-DA-0-9241)
- National Institute of Allergy and Infectious Diseases (P30AI042853)
- 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 reduction, HIV, cognitive behavioral therapy, group therapy, culturally tailored interventions, HIV outpatients, binge drinking, alcoholism, medication adherence, Kenya
- MeSH terms
- Adult, Alcohol Drinking, Ambulatory Care, Counseling, Cultural Characteristics, Female, Humans, Kenya, Male, Patient Compliance, Psychotherapy, Group, Regression Analysis, HIV Infections, Cognitive Behavioral Therapy, Treatment Outcome, Epidemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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