Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa

• Published in: Drug and alcohol dependence 2020-10, Vol.215, p.108206-108206, Article 108206
• Main Authors: Gichane, Margaret W., Wechsberg, Wendee M., Ndirangu, Jacqueline, Browne, Felicia A., Bonner, Courtney Peasant, Grimwood, Ashraf, Shaikh, Najma, Howard, Brittni, Zule, William A.
• Format: Article
• Language: English
• Subjects: Acceptability; Accuracy; Adult; Alcohol and other drug use; Alcohol Drinking; Alcohol use; Alcohols; Antiretroviral agents; Antiretroviral therapy; Clinical outcomes; Design modifications; Ethanol; Evidence-based HIV intervention; Evidence-based medicine; Female; Fidelity; Gender; Health status; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Implementation; Implementation Science; Intervention; Male; Rehabilitation; Risk reduction; Risk Reduction Behavior; Shortages; Social Stigma; South Africa - epidemiology; Stigma; Substance abuse; Substance use; Women; Women's Health; Womens health; Workshops
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108206

•Hazardous alcohol use reduces antiretroviral adherence.•Few HIV and alcohol risk interventions have been implemented in real-world settings.•We found high acceptability, adoption, and fidelity of the Women’s Health CoOp.•Implementation costs were low at $1.40 per attendee.•Staff shortages, stigma, and limited social services challenged implementation. South Africa has the highest HIV prevalence globally, which disproportionately affects women. Hazardous alcohol use reduces antiretroviral adherence which can lead to adverse health. Few evidence-based interventions addressing hazardous alcohol use and HIV have been implemented in real-world settings. This study aimed to evaluate implementation outcomes from the Women’s Health CoOp (WHC)—an evidence-based gender-focused HIV intervention—which was implemented in Cape Town. We conducted this implementation science trial using a modified stepped-wedge design. Four health clinics were paired with four substance use rehabilitation programs and randomized into four cycles. Women living with HIV and who use alcohol or other drugs were recruited into each cycle (n = 120 each cycle). We assessed adoption, acceptability, appropriateness, cost, and fidelity using a mixed methods approach. Adoption: 100 % of staff trained in the WHC and designated as interventionists delivered one or more workshops. Acceptability: Interventionists found the WHC content beneficial to their patients and the WHC improved connections between clinical units in facilities. Appropriateness: The WHC aligned with facility goals to improve antiretroviral adherence and reduce alcohol use; however, there were implementation challenges, including staff shortages, stigma, and few places to refer women for supportive services. Cost: The cost of implementing the WHC was 20.59 ZAR (1.40 USD) per attendee. Fidelity: Interventionists implemented the WHC with high fidelity and quality. The findings suggest it is feasible to integrate the WHC into usual-care settings. Future efforts to scale up the intervention will need to address social and structural implementation challenges. NCT02733003 approved 1/21/2016.