Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya

• Published in: AIDS and behavior 2010-06, Vol.14 (3), p.669-678
• Main Authors: Papas, Rebecca K., Sidle, John E., Martino, Steve, Baliddawa, Joyce B., Songole, Rogers, Omolo, Otieno E., Gakinya, Benson N., Mwaniki, Michael M., Adina, Japheth O., Nafula, Tobista, Owino-Ong’or, Willis D., Bryant, Kendall J., Carroll, Kathleen M., Goulet, Joseph L., Justice, Amy C., Maisto, Stephen A.
• Format: Article
• Language: English
• Subjects: Acquired Immune Deficiency Syndrome; Adult; Alcohol Abuse; Alcohol Drinking - epidemiology; Alcoholism - therapy; Alcohols; Attendance; Cognition; Cognitive Behavioral Therapy - methods; Counseling; Cultural Characteristics; Feasibility Studies; Female; Health Psychology; HIV Infections - complications; HIV Infections - prevention & control; HIV Infections - psychology; HIV Infections - transmission; Humans; Infectious Diseases; Kenya; Kenya - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Outpatients; Patient Acceptance of Health Care; Patient Satisfaction; Pilot Projects; Public Health; Satisfaction; Sexually transmitted diseases; STD; Sub Saharan Africa; Training; Treatment Outcome
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-009-9647-6

Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run ( n  = 27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52–100% (women) and 21–36% (men), and by session 6 was 96–100% (women) and 89–100% (men). PDA effect sizes (Cohen’s d ) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.