title: Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia.
abstract: OBJECTIVE
  To test the feasibility and effectiveness of brief counseling intervention (BCI) and naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia.
  
  
  METHODS
  Using a factorial randomized controlled trial design, patients were randomized into: naltrexone (NTX), brief behavioral compliance enhancement therapy (BBCET), treatment as usual (TAU) and BCI.
  
  
  METHODS
  In the Tomsk Oblast, hospitalized TB patients diagnosed with alcohol use disorders (AUDs) by the DSM-IV were referred at the start of TB treatment. Of the 196 participants, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease) and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%); 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day.
  
  
  METHODS
  Primary outcomes were 'favorable' TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as four drinks per day and five drinks per day for women and men, respectively, and TB adherence, measured as percentage of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on 'intention-to-treat' was performed for multivariable analysis.
  
  
  RESULTS
  Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n = 111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P = 0.02).
  
  
  CONCLUSIONS
  In Tomsk Oblast, Russia, tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes.
authors.affiliation: Harvard Medical School, Brigham and Women’s Hospital, Division of Global Health Equity, 75 Francis Street, Boston, MA 02115, USA. sshin@partners.org
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.forename: Viktoria
authors.initials: V
authors.lastname: Livchits
authors.forename: Hilary Smith
authors.initials: HS
authors.lastname: Connery
authors.forename: Alan
authors.initials: A
authors.lastname: Shields
authors.forename: Sergei
authors.initials: S
authors.lastname: Yanov
authors.forename: Galina
authors.initials: G
authors.lastname: Yanova
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.forename: Adrianne K
authors.initials: AK
authors.lastname: Nelson
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
mesh_terms: D000328:Adult; D064829:Alcohol Abstinence; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000150:complications / Q000517:prevention & control*; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003376:Counseling; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D010349:Patient Compliance; D012426:Russia; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000628:therapy*
chemical_list: D000427:Alcohol Deterrents; D009271:Naltrexone
keywords: Alcohol interventions; Russia; alcohol use disorders; behavioral interventions; clinical trial; tuberculosis.