title: Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Randomized clinical trial comparing CBT against a usual care assessment-only control.
  
  
  METHODS
  A large HIV out-patient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration.
  
  
  METHODS
  Seventy-five HIV-infected out-patients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking.
  
  
  METHODS
  Percentage of drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Time line Follow back method.
  
  
  RESULTS
  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.
authors.affiliation: Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906,USA. rebecca_papas@brown.edu
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Papas
authors.forename: John E
authors.initials: JE
authors.lastname: Sidle
authors.forename: Benson N
authors.initials: BN
authors.lastname: Gakinya
authors.forename: Joyce B
authors.initials: JB
authors.lastname: Baliddawa
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mwaniki
authors.forename: Rogers
authors.initials: R
authors.lastname: Songole
authors.forename: Otieno E
authors.initials: OE
authors.lastname: Omolo
authors.forename: Allan M
authors.initials: AM
authors.lastname: Kamanda
authors.forename: David O
authors.initials: DO
authors.lastname: Ayuku
authors.forename: Claris
authors.initials: C
authors.lastname: Ojwang
authors.forename: Willis D
authors.initials: WD
authors.lastname: Owino-Ong'or
authors.forename: Magdalena
authors.initials: M
authors.lastname: Harrington
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Hogan
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D003466:Cultural Characteristics; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D011615:Psychotherapy, Group; D012044:Regression Analysis; D016896:Treatment Outcome