Abstract:
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.