Department of Psychiatry, College of Health Sciences, Parirenyatwa Group of Hospitals, Avondale, Zimbabwe.
Psychiatric Hospital, Harare Central Hospital, Southerton, Zimbabwe.
Addict Sci Clin Pract. 2019 Apr 5;14(1):16. doi: 10.1186/s13722-019-0143-7.
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.
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).
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.
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.
在 HIV 感染患者中饮酒与危险性行为、对高效抗逆转录病毒治疗的依从性差、治疗失败和生理损害增加有关。本研究的目的是为试验中的结局评估提供参考，评估在津巴布韦为 PLWH 提供简短的动机性访谈/认知行为疗法（MI/CBT）干预与世界卫生组织 mhGAP 干预治疗酒精使用问题的可行性，并在随机对照试验设计中在 3 个月时评估这些干预措施对酒精使用、功能和 CD4 计数的有效性。
通过改编现有的基于证据的心理治疗方法，为津巴布韦的一家三级艾滋病毒护理诊所开发了一种针对 HIV 感染患者酒精使用问题的干预措施，并评估其可行性。注册普通护士使用手册化方案来提供干预措施。招募了 40 名患者，并将他们随机分为接受 MI/CBT 干预或世界卫生组织 mhGAP 酒精使用障碍干预指南（每组 20 名患者）。
40 名入组患者中，31 名成功随访 3 个月，失访率为 23%。两组的 AUDIT 评分随时间均呈显著下降（p<0.001），但组间无统计学差异，平均差异为 0.80，标准误差为 2.07，p=0.70。对于 CD4 计数，MI/CBT 和世界卫生组织 mhGAP IG 组的基线中位数和四分位间距分别为 218（274）和 484（211.50）。在随访时，MI/CBT 和世界卫生组织 mhGAP IG 组的 CD4 计数中位数和四分位间距分别为 390（280）和 567（378），提示两个治疗组的免疫参数均有所改善。
这项试点研究的结果表明，由注册普通护士为有问题的酒精使用者提供简短的 MI/CBT 在该人群中是可行的，但需要采取额外措施来提高保留率。然而，需要特别注意提高保留率的机制。
泛非临床研究注册中心，当前 PACTR201509001211149。
