Introduction of an Alcohol-Related Electronic Screening and Brief Intervention (eSBI) Program to Reduce Hazardous Alcohol Consumption in Namibia\u2019s Antiretroviral Treatment (ART) Program

A M Tang,D Prybylski,N Mutenda,A Kerrigan,D D Walker,N Hamunime,M Zahralban-Steele,S Agolory,G Kanyinga,R A Adams,S Sughrue,T Rennie,C Fischer-Walker,S Y Hong

doi:10.1007/s10461-019-02648-9

Abstract

Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.

Highlights

Introduction of an AlcoholRelated Electronic Screening and Brief Intervention Program to Reduce Hazardous Alcohol Consumption in Namibia’s Antiretroviral Treatment (ART) ProgramA
We developed and piloted an alcohol-related Electronic screening and brief interventions (eSBI) specific to the Namibian context, with the overall objectives of: (1) screening for hazardous alcohol use and associated risk factors among people living with HIV (PLHIV) attending two antiretroviral therapy (ART) clinics, and (2) assessing the feasibility and acceptability of implementing this type of tool in ART sites in Namibia
“taking ARV medications” was changed to “drinking ARV medications”; “small beer” was changed to “dumpie”; “traditional homebrew” was changed to “tombo”; “bar” was replaced with “shebeen”; and the term “tot” was used in place of “shot”; (2) The risk scale (“low, moderate and high risk”) was modified to “low, middle, and high danger” as the term “danger” was said to be better understood than the term “risk”; (3) We created and incorporated graphics of standard alcohol types and standard drink volumes using bottles and glasses that would be more widely recognized by Namibians; (4) We incorporated reasons and ideas for limiting alcohol use that were elicited from our focus group discussions (FGDs); and (5) We provided participants with local resources that they could contact for additional help

Summary

Introduction

A sub-Saharan country in southwest Africa, has been severely affected by the HIV epidemic. With approximately 217,000 people living with HIV (PLHIV), Namibia has one of the world’s highest HIV prevalence rates, estimated to be approximately 14% in the general adult population and up to 23.7% in the most heavily affected region in the north [1]. The 2014 WHO Global Status Report on Alcohol and Health reported the prevalence of alcohol use disorders and alcohol dependence in Namibia to be significantly higher compared to the overall African region (5.1% vs 3.3% and 2.2% vs 1.4%, respectively) [4]. Namibia’s alcohol per capita consumption and prevalence of heavy episodic (binge) drinking ranked as the third and sixth highest, respectively, out of 45 countries in the African region [4]

Objectives

Methods

Results

Conclusion