Population Council Research that makes a difference

Although alcohol can interfere with the practice of HIV prevention behaviors and the efficacy of antiretroviral therapy (ART), little is known about whether voluntary counseling and testing (VCT) and ART providers perceive alcohol abuse as a problem among their clients. This intervention sought to integrate alcohol risk-reduction counseling into VCT. The goals of the study were to improve providers' inquiries about clients' and partners' alcohol use, screening of clients for alcohol, provision of feedback of screening results, and referrals to care and support. Other desired outcomes were increased exposure to alcohol education materials and clients' and providers' receptiveness toward the program.

In 2006, a baseline study was conducted in 18 static and seven mobile sites from three provinces in Kenya—Nairobi, Coast, and Central. Researchers conducted 1,073 exit interviews with VCT clients as well as 19 focus group discussions with VCT counselors, ART service providers and their patients, and providers and patients from substance abuse recovery centers.

Based on the baseline study results, project partner Liverpool VCT and Care developed an alcohol training module to train VCT counselors on a revised counseling protocol that integrated alcohol risk-reduction counseling into the regular VCT service provision. The protocol guided providers to ask all clients about their alcohol use, screen alcohol users for their levels of alcohol use, offer them a brief intervention, and make appropriate referrals.

One year after implementation of activities at the intervention sites, follow-up data were collected from 1,058 VCT clients from the same sites, using the same data-collection methods as the baseline survey. The follow-up questionnaire had a section that explored exposure to the intervention.

Key findings

• Introduction of the intervention significantly increased alcohol risk-reduction counseling at the VCT centers. At follow-up, 77 percent of clients from intervention sites were screened compared with 33 percent at the comparison sites (p < .001).
• Clients were open to receiving alcohol counseling during VCT. Almost all (97 percent and 90 percent of clients at the intervention and comparison sites, respectively) reported that they would have been extremely receptive to discussions about alcohol use while at the VCT center.
• The alcohol counseling component increased VCT time by seven minutes, which did not bother the providers.
• Referrals to alcohol treatment and care facilities were weak. Ten percent of intervention site clients were referred to an alcohol treatment center, as were 8 percent of comparison site clients, while 8 percent of intervention site clients and 5 percent of comparison site clients were asked to join Alcoholics Anonymous (AA). Some of the reasons that providers gave for this weak referral system were that alcohol treatment and care facilities are few and unaffordable for many people, and that they (the providers) did not have adequate information about these facilities.
• Clients from the intervention sites displayed more concrete intentions to change behavior, stating that they would reduce or stop their alcohol intake. Forty-five percent of respondents from the intervention sites said they would reduce their alcohol intake, compared with 24 percent from the comparison sites. Similar proportions said that they would stop their alcohol intake altogether (45 percent and 24 percent at the intervention and comparison sites, respectively).
• Half of the intervention sites' clients could recall seeing a poster on alcohol at the facility, but the likelihood of having a brochure at hand was minimal, largely because of high demand. Posters and brochures were distributed at the intervention sites, and clients at these sites were more likely to report having seen the posters compared with their counterparts from the comparison sites (53 percent vs. 16 percent; p < .001).
  
  

Overall, the results indicate that it is feasible to integrate alcohol risk-reduction counseling into VCT, and that it is generally accepted by providers and clients alike. The intervention sites registered better study outcomes than the comparison sites, which implies that the trained providers were able and willing to implement the revised protocol. The alcohol counseling component increased VCT time by seven minutes, which providers did not find burdensome. This study therefore supports the formal integration of alcohol reduction counseling into VCT services in Kenya.

The Population Council is currently conducting a follow-on study under the APHIA II project.  Full details on the study can be found on that project page.