1. The Kenya Health Behavior Study: Piloting Results
(NIAAA R21AA016884)
Rebecca K. Papas, PhD Associate Research Scientist Yale School of Medicine

2. Kenya Health Behavior Study collaborators
Rebecca Papas, Ph.D.
David Ayuku, Ph.D.
John Sidle, M.D.
Otieno Omolo, M.D.
Joyce Ballidawa, M.S.
Rogers Songole, M.S.
Willis Owino-Ong’or, M.D.
Claris Ojwang
Steven Martino, Ph.D.
Stephen Maisto, Ph.D.
Kathleen Carroll, Ph.D.
Joseph Goulet, Ph.D.
Amy Justice, M.D., Ph.D.

3. Additional acknowledgments
Kendall Bryant, PhD
Chematics, Inc.
Indiana University School of Informatics
Funded by: National Institute on Alcohol Abuse and Alcoholism (R21AA01688)
No commercial conflict of interest

4. Alcohol in Kenya Hazardous drinking in Eldoret
68% general medicine patients
53% HIV patients
Traditional brew (illegal)
54% rural Eldoret patients
21% town Eldoret patients
Adverse medical outcomes for HIV infected
Dose-response relationship
Shaffer et al., 2004; Justice et al., 2006

5. HIV prevalence and risk in Africa
2/3 worldwide cases found in sub-Saharan Africa
5.1% prevalence in Kenya
~10% condom use among HIV patients
Women
Men
Adults
6.7%
3.5%
Young people (ages 15-25)
4.5%
0.8%
National AIDS Control Council Kenya, 2007

6. In line for the latest batch of chang’aa (spirits)

7. Kenya Health Behavior Study goals
I. Culturally adapt behavioral treatment to reduce alcohol use for group paraprofessional delivery and adapt methods to Kenyan cultural context
II. Determine feasibility through piloting
III. Conduct a small randomized clinical trial of cognitive behavioral treatment compared to existing HIV support group

8. AMPATH Patients in HIV care (n = 65,000) Electronic medical records
50% on ARVs
Electronic medical records
Full reference laboratory
Comprehensive approach
Food “prescriptions”

9. Goal I: Cultural adaptation tasks
1. Translate/adapt Kiswahili survey
2. Estimate alcohol content of traditional brew
3. Tailor intervention to cultural context
4. Train group facilitators

10. Busaa (“maize beer”) is fermented from rotting maize flour and yeast made from millet

11. Chang’aa (spirits) are distilled from busaa waste and from sugar

12. Serving sizes of chang’aa

13. Busaa is sold in larger serving sizes

14. Goal II: Determine Feasibility Through Piloting:
Methods and Results

15. Methods: Pilot groups Build facilitator skills Hone treatment manual
6 session CBT
Inclusion criteria
HIV clinical patients
Any alcohol in past month
English or Swahili speaking
One hour travel time
No plans to move within next 8 weeks

16. Results: Pilot groups N=5 (3 for women, 2 for men) Retention:
Men 76%, Women 78%
(those who attended ≥1 session, n=27)
14 individuals did not attend any sessions
Withdrawal symptoms
Brewers and barmaids

17. Treatment Attenders: Group Characteristics, Retention and Size

19. Reasons for Nonattendance
Never showed
Thought would result in job training (1m)
Could not be reached (3f, 3m)
Thought videotaping would be made public (1f)
Missed sessions
Childcare-related issues (1m, 1f)
Psychiatric hospitalization (1f)
Psychiatric evaluation (1f)
Drank alcohol before session (3f, 2m)
Pre-treatment procedure took too long (1f)
Thought detox meds were harmful (1f)
Work conflict (2f, 1m)

23. Next steps Stage 1 Randomized Clinical Trial
56 HIV-infected patients (50% women)
ARV-eligible or initiated on ARVs in past 12 months
6 CBT group sessions compared to HIV support
In Kiswahili
Yale Adherence and Competence Scale ratings
Survey test-retest reliability

24. Addressing retention challenges
Letter to employer about treatment
Phone reminders and follow-up
Increased staff size
Transport provided to 1st CBT session
10-minute problem-solving checklist

25. Overview of Randomized Clinical Trial

27. Questions?