Population Council Research that makes a difference

Kenya National AIDS Control Council
First National Biennial HIV and AIDS Research Conference
17–20 May 2011

Abstract

"Utilization of cell phones to follow up alcohol-dependent clients attending HIV counseling and testing (HCT) services"
Inviolata Njeri, Samuel Kalibala, Wanjiru Mukoma, William Sinkele, Waimar Tun, and Humphres Evelia

Background
Observational studies have shown that alcohol use and abuse could lead to behavior that increases risk of HIV. A study by the Population Council; Liverpool VCT, Care & Treatment; and Support for Addiction Prevention and Treatment in Africa Centre established the feasibility of integrating alcohol abuse screening and counseling into HTC but was limited in referrals and follow-up. In 2010 the three organizations conducted a study to establish the feasibility of using cell-phones in following-up persons identified as alcohol dependent.

Methods
Pre- and post-test design study was conducted in 15 HTC sites from Nyanza, Coast, Nairobi, and Eastern. 725 clients were recruited after scoring CAGE-positive (i.e., considered alcohol abusers after answering yes to two of four questions on an alcohol dependence screening test), indicating possession of a cell phone, and consenting to being contacted on that cell phone. 75 HTC counselors were trained for one week on screening and alcohol risk-reduction counseling as well as on the use of cell phones in following up with clients. Each study site was given a cell phone. The intervention used the Kiswahili words Mambo? (What’s up?), Poa (Cool), and Shida (Problem). Counselors sent Mambo? SMS, participants were to reply Shida if they had problem(s) reducing alcohol intake and Poa if they had no problems.

Results
Five SMS were sent to each client at one-month intervals. 2,242 Mambo SMS were sent out; 1,178 Poa and 82 Shida responses were received, giving a response rate of 56% (1,260). Those who sent a Shida response were called back by the counselors and received counseling about the problems they raised, which included a lack of family/spousal support; a gap in socializing after abstaining from alcohol use; and a failure to reduce intake.

Conclusion
It is feasible to use the cell phone as follow-up tool, to track progress in the implementation of alcohol-related interventions. The use of cell phones is acceptable to clients and convenient for counselors and provides needed counseling support for alcohol-dependent HTC clients to reduce alcohol-related sexually risky practices. 

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