CHARTZ

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Project Summary/Abstract The intersection of unhealthy alcohol use and HIV infection is most significant in sub-Saharan Africa (SSA) where HIV prevalence exceeds 20% in some populations and alcohol consumption is on the rise. Most HIV treatment and prevention programs in SSA do not have evidence-based alcohol interventions and the professional mental health workforce is extremely limited. Alcohol brief interventions (BI), which have been moderately effective in other settings, were not effective in SSA for unhealthy alcohol use among people with HIV in several previous trials. Unhealthy alcohol use is often complicated by comorbid mental illness and/or other substance use. We previously demonstrated the feasibility, acceptability, and potential effectiveness of a transdiagnostic model called Common Elements Treatment Approach (CETA) for people with HIV and unhealthy alcohol use. CETA was designed for delivery by lay providers (non-professionals with limited or no previous mental health experience) and can address a range of conditions (including unhealthy alcohol use) within a single protocol delivered over 6-12 therapy sessions. CETA was evaluated in 3 previous randomized trials and found to be effective for a range of conditions in trauma-affected and marginalized populations. CETA HIV Alcohol Reduction Trial in Zambia (CHARTZ), a research project within the Zambia Alabama HIV Alcohol Comorbidities Program, is a hybrid effectiveness-implementation trial to evaluate the effects of CETA, and a novel alcohol BI, on HIV, alcohol, and comorbidity outcomes. Adults (18+ years old) with HIV, unhealthy alcohol use, and suboptimal engagement in HIV care at public sector HIV clinics in Lusaka will be enrolled and randomized to the standard of care (ART adherence counseling), BI alone, or BI plus CETA. The BI and CETA will be provided by HIV peer educators, a cadre of lay counselors who are embedded at HIV clinics across Zambia. Patient reported outcome measures (for alcohol use, mental illness, and other substance use) and HIV electronic medical records (for ART adherence, retention in HIV care, viral suppression) will be used to assess trial eligibility and evaluate outcomes at 6 and 12 months. Phosphatidylethanol, a direct alcohol biomarker, will be measured to strengthen assessment of trial outcomes. Implementation factors related to the integrated delivery of CETA and the BI will be evaluated including cost and cost effectiveness. In summary, CHARTZ will generate evidence on psychological treatments for unhealthy alcohol use that have strong potential for implementation in low-resource settings and can address complex and overlapping behavioral issues that undermine HIV treatment and prevention.