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Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study

BACKGROUND: Alcohol use in HIV infected patients is associated with risky sexual behaviour, poor adherence to Highly Active Antiretroviral Therapy, treatment failure and increased physiologic harm. The objectives of the study were to pilot the outcome assessments to be used in the trial proper, asse...

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Autores principales: Madhombiro, Munyaradzi, Dube, Bazondlile, Dube, Michelle, Zunza, Moleen, Chibanda, Dixon, Rusakaniko, Simbarashe, Seedat, Soraya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451208/
https://www.ncbi.nlm.nih.gov/pubmed/30953549
http://dx.doi.org/10.1186/s13722-019-0143-7
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author Madhombiro, Munyaradzi
Dube, Bazondlile
Dube, Michelle
Zunza, Moleen
Chibanda, Dixon
Rusakaniko, Simbarashe
Seedat, Soraya
author_facet Madhombiro, Munyaradzi
Dube, Bazondlile
Dube, Michelle
Zunza, Moleen
Chibanda, Dixon
Rusakaniko, Simbarashe
Seedat, Soraya
author_sort Madhombiro, Munyaradzi
collection PubMed
description BACKGROUND: Alcohol use in HIV infected patients is associated with risky sexual behaviour, poor adherence to Highly Active Antiretroviral Therapy, treatment failure and increased physiologic harm. The objectives of the study were to pilot the outcome assessments to be used in the trial proper, assess the feasibility of delivery of a brief MI/CBT intervention compared to an WHO mhGAP intervention for problematic alcohol use in PLWH in Zimbabwe, and pilot the effectiveness (on alcohol use, functionality and CD4 count) of these interventions at 3 months in a randomised controlled trial design. METHODS: An intervention for HIV infected patients with problematic alcohol use, developed through adaptation of existing evidence based psychological treatments, was assessed for its feasibility at a tertiary HIV care clinic in Zimbabwe. Registered general nurses, using a manualised protocol, delivered the intervention. Forty patients were recruited and randomised to receive either an MI/CBT intervention or the WHO mhGAP Intervention Guide for AUDs (n = 20 patients per group). RESULTS: Out of 40 participants enrolled, 31 were successfully followed up for 3 months with a loss to follow-up rate of 23%. There was a statistically significant decrease in AUDIT score over time in both groups (p < 0.001), however no statistically significant group difference with a mean difference of 0.80, standard error of 2.07 and p = 0.70. For the CD4 count, the median and interquartile ranges at baseline for MI/CBT and WHO mhGAP IG groups were 218 (274) and 484 (211.50), respectively. At follow-up, median and interquartile ranges for the CD4 count for MI/CBT and WHO mhGAP IG groups were 390 (280) and 567 (378), respectively, indicative of improvement in immunological parameters in both arms. CONCLUSION: The findings from this pilot study suggests that a brief MI/CBT delivered by Registered General Nurses for problematic alcohol use is feasible in this population but will require the implementation of additional measures to improve retention. However, mechanisms to improve retention need special attention. Trial registration Pan African Clinical Trial Registry, current PACTR201509001211149
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spelling pubmed-64512082019-04-16 Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study Madhombiro, Munyaradzi Dube, Bazondlile Dube, Michelle Zunza, Moleen Chibanda, Dixon Rusakaniko, Simbarashe Seedat, Soraya Addict Sci Clin Pract Research BACKGROUND: Alcohol use in HIV infected patients is associated with risky sexual behaviour, poor adherence to Highly Active Antiretroviral Therapy, treatment failure and increased physiologic harm. The objectives of the study were to pilot the outcome assessments to be used in the trial proper, assess the feasibility of delivery of a brief MI/CBT intervention compared to an WHO mhGAP intervention for problematic alcohol use in PLWH in Zimbabwe, and pilot the effectiveness (on alcohol use, functionality and CD4 count) of these interventions at 3 months in a randomised controlled trial design. METHODS: An intervention for HIV infected patients with problematic alcohol use, developed through adaptation of existing evidence based psychological treatments, was assessed for its feasibility at a tertiary HIV care clinic in Zimbabwe. Registered general nurses, using a manualised protocol, delivered the intervention. Forty patients were recruited and randomised to receive either an MI/CBT intervention or the WHO mhGAP Intervention Guide for AUDs (n = 20 patients per group). RESULTS: Out of 40 participants enrolled, 31 were successfully followed up for 3 months with a loss to follow-up rate of 23%. There was a statistically significant decrease in AUDIT score over time in both groups (p < 0.001), however no statistically significant group difference with a mean difference of 0.80, standard error of 2.07 and p = 0.70. For the CD4 count, the median and interquartile ranges at baseline for MI/CBT and WHO mhGAP IG groups were 218 (274) and 484 (211.50), respectively. At follow-up, median and interquartile ranges for the CD4 count for MI/CBT and WHO mhGAP IG groups were 390 (280) and 567 (378), respectively, indicative of improvement in immunological parameters in both arms. CONCLUSION: The findings from this pilot study suggests that a brief MI/CBT delivered by Registered General Nurses for problematic alcohol use is feasible in this population but will require the implementation of additional measures to improve retention. However, mechanisms to improve retention need special attention. Trial registration Pan African Clinical Trial Registry, current PACTR201509001211149 BioMed Central 2019-04-05 2019 /pmc/articles/PMC6451208/ /pubmed/30953549 http://dx.doi.org/10.1186/s13722-019-0143-7 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Madhombiro, Munyaradzi
Dube, Bazondlile
Dube, Michelle
Zunza, Moleen
Chibanda, Dixon
Rusakaniko, Simbarashe
Seedat, Soraya
Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title_full Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title_fullStr Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title_full_unstemmed Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title_short Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study
title_sort intervention for alcohol use disorders at an hiv care clinic in harare: a pilot and feasibility study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451208/
https://www.ncbi.nlm.nih.gov/pubmed/30953549
http://dx.doi.org/10.1186/s13722-019-0143-7
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