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Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India

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Abstract

Alcohol use has a deleterious effect on the health status of persons living with HIV, negatively affecting antiretroviral adherence and increasing the risk of transmission. Alcohol use is not an isolated behavior but intimately linked to stigma and poor psychological status among other factors. This paper utilizes a crossover design to test the efficacy of three multilevel interventions, individual counselling (IC), group intervention (GI) and collective advocacy (CA) for change, among HIV positive males who consume alcohol, treated at five ART Centers in urban Maharashtra, India. While GI shows a significant effect on the largest number of outcome variables, IC through its psychosocial emphasis demonstrated a significant impact over time on stigma and depression, and CA with its emphasis on societal change showed positive impact on stigma and advocacy for self and others. Each of the interventions had variable effects on CD4 count and viral load.

Clinical Registration Number: NCT03746457; Clinical Trial.Gov

Resumen

El consumo de alcohol tiene un efecto nocivo en el estado de salud de las personas que viven con VIH, afectando negativamente la adherencia a los antirretrovirales y aumentando el riesgo de transmisión del virus. El consumo de alcohol no es un comportamiento aislado, sino que está íntimamente relacionado con el estigma y el mal estado psicológico, entre otros factores. Este documento utiliza un diseño cruzado para evaluar la eficacia de tres intervenciones: asesoramiento individual, intervención grupal y defensa colectiva para el cambio, entre hombres con VIH que consumen alcohol que reciben tratamiento en cinco centros de terapia antiretroviral en la zona urbana de Maharashtra, India. Si bien la intervención grupal muestra un efecto significativo en el mayor número de variables de interés, el asesoramiento individual a través de su énfasis psicosocial demostró un impacto significativo en el estigma y la depression a largo plazo, y la defensa colectiva con su énfasis en el cambio social mostró un impacto positivo en el estigma y la defensa de sí mismo y otros

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Data Availability

As per agreement with NIAAA/NIH, de-identified data will be available in 2023.

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Acknowledgements

We appreciate the colleagueship and support of Drs. Kendall Bryant, our scientific collaborator and Deidra Roach, our project officer NIAAA. We are grateful to the other PIs, Drs. Niranjan Saggurti, Director of India Country office of Population Council and Ravi Verma, Director of the Asia Regional Office of the International Center for Research on Women (ICRW) for their contributions to conceptualization and methodology. The project depended on the skills and management of the project coordinators, Drs. Melita Vaz of Population Council and Priti Prabhughate of ICRW and Rajendra Singh and Parasnath Verma of ICRW. We are thankful to our research investigators: Deepak Sonawane, Triloki Nath, Sachin Sakpal, Purna Kumal, Santosh Surve, Dnyaneshwar Khandekar, Santosh Salunke, Gopal Gujar, Jagdeep Bansod, Vijay Pawar; and our intervention facilitators from NMP+, Ramchandra Salunke, Ashok Dhokle, Vaijnath Mane and Ashok Gheware for their hard work and unwavering commitment. This study depended on the support of National AIDS Control organization, the Maharashtra State AIDS Control Society, the Mumbai District AIDS Control Society, the five participating hospitals and the staff of the ART Centers. Lastly, we would like to thank study participants who willingly gave us their time and attention.

Funding

National Institute for Alcoholism and Alcohol Abuse of US National Institutes of Health (Grant No. U01AA021990); PD/PIs Schensul S, Saggurti, Schensul J, Sarna A, Verma R; 2015–2020.

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Authors and Affiliations

  1. Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA

    Stephen L. Schensul, James Grady & Joseph A. Burleson

  2. Department of Infectious Diseases, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Toan Ha

  3. Institute for Community Research, Hartford, CT, USA

    Jean J. Schensul

  4. T.N. Medical College and B.Y.L. Nair Ch. Hospital, Mumbai, India

    Sushma Gaikwad

  5. Seth G S Medical College, Mumbai, India

    Kavita Joshi

  6. Lokmanya Tilak Muncicipal Medical College, Mumbai, India

    Rupal Malye

  7. Population Council, India Country Office, New Delhi, India

    Avina Sarna

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  1. Stephen L. Schensul
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  2. Toan Ha
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Contributions

All authors have made significant contributions to data collection, analysis and writing.

Corresponding author

Correspondence to Stephen L. Schensul.

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None declared.

Ethical Approval

The study was approved on the US-side by the University of Connecticut Health IRB also acting for the Institute for Community Research and on the India side by the National AIDS Control Organization, the Health Ministry Screening Committee, the Indian Council for Medical Research, the IRBs of the Population Council and the International Center for Research on Women and the Ethical Review committees of T.N. Medical College and B.Y.L. Nair Ch. Hospital, Seth G S Medical College and Lokmanya Tilak Municipal Medical College.

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Schensul, S.L., Ha, T., Schensul, J.J. et al. Multilevel and Multifactorial Interventions to Reduce Alcohol Consumption and Improve ART Adherence and Related Factors Among HIV Positive Men in Mumbai, India. AIDS Behav 25 (Suppl 3), 290–301 (2021). https://doi.org/10.1007/s10461-021-03303-y

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