The efficacy of a brief intervention to reduce alcohol use in persons with HIV in South Africa, a randomized clinical trial

BackgroundSince there is a high prevalence of high risk alcohol use in patients with HIV in Africa, with negative health effects, there is a need for short interventions to reduce alcohol use.MethodsWe studied the efficacy of a short intervention aiming to reduce alcohol use based on the Information-Motivation-Behavioural Skills Model in patients with HIV with high alcohol use (measured by AUDIT). The study was performed in three outpatient clinics in South Africa. The intervention group received in one-session intervention a personalized feedback on AUDIT results trying to make people aware that they are in the medium- or high-risk drinking category. Both the intervention and the control group received a health education leaflet.ResultsA total of 560 patients participated in the study with a follow up of 1 year. There was a significant decrease in total AUDIT scores between baseline and follow up points 1 (5 months) and 2 (1 year) in both groups. There was no significant decrease between time points 1 and 2. However, between the intervention and control groups there was no difference in reduction of alcohol use to abstinence or low risk alcohol use over time as there was no difference in absolute decrease in AUDIT-score or percentage of change in AUDIT score. The intervention had no influence on the quality of life outcomes, depression scores, stigma, tobacco use, viral load and therapy adherence at both time points. In all secondary outcomes, there was no significant interaction between intervention and time.ConclusionThe brief intervention was not successful at reducing alcohol use both 5 and 12 months after the intervention. However, there was a beneficial effect on reported hazardous or harmful alcohol use at least over a short term follow up period in both study groups. It might be that only an interview and/or the distribution of a health leaflet can be successful in reducing alcohol use but this needs to be investigated with more objective measures of alcohol use. To sustain an effect, most likely repetitive contacts with hazardous or harmful alcohol drinkers will be needed during a long follow up period.

背景：非洲人类免疫缺陷病毒（HIV）感染者中高风险饮酒的患病率较高，且会带来不良健康影响，因此亟需开展简短干预措施以减少饮酒行为。
方法：本研究基于信息-动机-行为技能模型（Information-Motivation-Behavioural Skills Model），针对酒精使用量较高（通过酒精使用障碍识别测试（Alcohol Use Disorders Identification Test，AUDIT）评估）的HIV感染者，开展了一项旨在减少饮酒行为的简短干预效果研究。研究在南非的三家门诊诊所开展：干预组在单次干预中接收了基于其AUDIT检测结果的个性化反馈，以帮助其意识到自身属于中度或高风险饮酒人群；干预组与对照组均发放了健康宣教手册。
结果：本研究共纳入560名患者，随访时长为1年。两组患者在基线与随访节点1（5个月）、随访节点2（1年）的AUDIT总分均显著下降，但节点1与节点2之间无显著降低。随着时间推移，干预组与对照组在饮酒量降至戒断或低风险饮酒水平的比例上无显著差异，AUDIT总分的绝对下降值及变化百分比亦无组间差异。在两个随访节点中，该干预措施对患者的生活质量、抑郁评分、病耻感、烟草使用情况、病毒载量及治疗依从性均无显著影响；所有次要结局指标中，干预措施与时间均未出现显著交互作用。
结论：该简短干预在干预后5个月及12个月均未能有效减少饮酒行为。不过，至少在短期随访期间，两组患者自述的危险/有害饮酒情况均得到了一定改善。推测仅通过访谈或/和发放健康宣教手册即可实现饮酒行为的减少，但该结论需采用更客观的饮酒量评估手段进一步验证。若要维持干预效果，在长期随访过程中很可能需要对存在危险/有害饮酒行为的患者进行多次干预接触。