Skip to main content

Advertisement

Log in

Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya

AIDS and Behavior Aims and scope Submit manuscript

Abstract

Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run (n = 27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52–100% (women) and 21–36% (men), and by session 6 was 96–100% (women) and 89–100% (men). PDA effect sizes (Cohen’s d) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. UNAIDS/WHO. AIDS epidemic update: December 2007. Geneva/UNAIDS/WHO. Ref Type: Report.

  2. Ayisi JG, van Eijk AM, ter Kuil OF, et al. Risk factors for HIV infection among asymptomatic pregnant women attending an antenatal clinic in western Kenya. Int J STD AIDS. 2000;11:393–401.

    Article  CAS  PubMed  Google Scholar 

  3. Seage GR III, Holte S, Gross M, et al. Case-crossover study of partner and situational factors for unprotected sex. J Acquir Immune Defic Syndr. 2002;31:432–9.

    PubMed  Google Scholar 

  4. Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29:1190–7.

    Article  PubMed  Google Scholar 

  5. Justice AC, Lasky E, McGinnis KA, et al. Comorbid disease and alcohol use among veterans with HIV infection: a comparison of measurement strategies. Med Care. 2006;44(Suppl 2):S52–60.

    Article  PubMed  Google Scholar 

  6. Othieno CJ, Kathuku DM, Ndetei DM. Substance abuse in outpatients attending rural and urban health centres in Kenya. East Afr Med J. 2000;77:592–5.

    CAS  PubMed  Google Scholar 

  7. Saunders JB, Aasland OG, Amundsen A, Grant M. Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption-I. Addiction. 1993;88:349–62.

    Article  CAS  PubMed  Google Scholar 

  8. World Health Organization. Global Status Report on Alcohol 2004. Geneva, WHO. Ref Type: Report.

  9. Papas RK, Sidle JE, Wamalwa ES, et al. Estimating alcohol content of traditional brew in western Kenya using culturally relevant methods: the case for cost over volume. AIDS Behav. 2009 (in press).

  10. Shaffer DN, Njeri R, Justice AC, Odero WW, Tierney WM. Alcohol abuse among patients with and without HIV infection attending public clinics in western Kenya. East Afr Med J. 2004;81:594–8.

    CAS  PubMed  Google Scholar 

  11. Kalichman SC, Simbayi LC, Vermaak R, et al. Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa. Ann Behav Med. 2009 (in press).

  12. Chesney MA, Donnell D, Seage GR, Bryant KL. Project EXPLORE: impact of alcohol use on HIV sero-incidence among high-risk MSM in a large-scale prospective prevention intervention. Alcohol Clin Exp Res. 2009;33(Suppl 1). Ref Type: Abstract.

  13. Bandura A. Principles of behavior modification. New York: Holt, Rinehart & Winston; 1969.

    Google Scholar 

  14. Monti PM, Kadden RM, Rohsenow DJ, Cooney NL, Abrams DB. Treating alcohol dependence: a coping skills training guide. 2nd ed. New York: The Guilford Press; 2002.

    Google Scholar 

  15. Kadden RM, Cooney NL, Getter H, Litt MD. Matching alcoholics to coping skills or interactional therapy: posttreatment results. J Consult Clin Psychol. 1989;57:698–704.

    Article  CAS  PubMed  Google Scholar 

  16. Miller WR, Zweben J, Johnson WR. Evidence-based treatment: why, what, where, when and how? J Subst Abuse Treat. 2005;29:267–76.

    Article  PubMed  Google Scholar 

  17. Project Match Research Group. Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58:7–29.

    Google Scholar 

  18. Jones DL, Ross D, Weiss SM, Bhat G, Chitalu N. Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. J Urban Health. 2005;82(3 Suppl 4):iv92–100.

    PubMed  Google Scholar 

  19. Osinowo HO, Olley BO, Adejumo AO. Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients. West Afr J Med. 2003;22:338–42.

    CAS  PubMed  Google Scholar 

  20. Bernal G, Bonilla J, Bellido C. Ecological validity and cultural sensitivity for outcome research: issues for cultural adaptation and development of psychosocial treatments with Hispanics. J Abnorm Child Psychol. 1995;23:67–82.

    Article  CAS  PubMed  Google Scholar 

  21. Sue S, Zane N. The role of culture and cultural techniques in psychotherapy. A critique and reformulation. Am Psychol. 1987;42:37–45.

    Article  CAS  PubMed  Google Scholar 

  22. Hall GCN. Psychotherapy research with ethnic minorities: empirical, ethical and conceptual issues. J Consult Clin Psychol. 2001;69:502–10.

    Article  CAS  PubMed  Google Scholar 

  23. Betz NE, Fitzgerald LF. Individual and diversity: theory and research in counseling psychology. Annu Rev Psychol. 1993;44:343–81.

    Article  CAS  PubMed  Google Scholar 

  24. Ramirez M. Multicultural psychotherapy: an approach to individual and cultural differences. Boston: Allyn & Bacon; 1999.

    Google Scholar 

  25. Sue DW, Ivey AE, Petersen PB. A theory of multicultural counseling and therapy. Pacific Grove: Brooks and Cole; 1996.

    Google Scholar 

  26. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: getting started and moving on from Stage I. Clin Psychol Sci Pract. 2001;8:133–42.

    Article  Google Scholar 

  27. National AIDS and STI Programme, Ministry of Health Kenya. Kenya AIDS Indicator Survey 2007: Preliminary Report. Nairobi, Kenya. Ref Type: Report.

  28. Einterz RM, Kimaiyo S, Mengech HNK, et al. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007;82:818.

    Google Scholar 

  29. National AIDS Control Council, Office of the President Kenya. UNGASS 2008 Country Report for Kenya, NACC, Nairobi. Ref Type: Report.

  30. Central Intelligence Agency. CIA—The World Factbook—Kenya. Available at: https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html. Accessed August 2, 2009. Ref Type: Electronic Citation.

  31. World Bank. World Development Report. 2002. Washington, DC, World Bank. Ref Type: Report.

  32. Njenga FG, Kigamwa PA. Mental health policy and programmes in Kenya. 2005. London, Royal College of Psychiatrists. Bulletin of the Board of International Affairs of the Royal College of Psychiatrists. Ref Type: Report.

  33. Ayuku D, Odero W, Kaplan C, De Bruyn R, De Vries M. Social network analysis for health and social interventions among Kenyan scavenging street children. Health Policy Plan. 2003;18:109–18.

    Article  PubMed  Google Scholar 

  34. POLICY Project—Kenya. From Despair to Hope: Women’s Right to Own and Inherit Property. 2005. Nairobi, Kenya, POLICY Project—Kenya; Kenya National Commission on Human Rights. Ref Type: Report.

  35. Carroll KM, Nich C, Sifry RL, et al. A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions. Drug Alcohol Depend. 2000;57:225–38.

    Article  CAS  PubMed  Google Scholar 

  36. Sobell LC, Sobell MB. Timeline Followback: a technique for assessing self-reported alcohol consumption. In: Litten RZ, Allen J, editors. Measuring alcohol consumption. 1st ed. New Jersey: Humana Press; 1992. p. 41–72.

    Google Scholar 

  37. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Brit J Addiction. 1989;84:1353–7.

    Article  CAS  Google Scholar 

  38. Chematics, Inc. Alco-Screen Technical Information. 2004. North Webster, Indiana, Chematics, Inc. Ref Type: Pamphlet.

  39. World Health Organization. WHO—Process of translation and adaptation of instruments. Available at: http://www.who.int/substance_abuse/research_tools/translation/en/index.html. Accessed August 12, 2009. Ref Type: Electronic Citation.

  40. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.

    Article  CAS  PubMed  Google Scholar 

  41. Alio AP, Daley EM, Nana PN, Duan J, Salihu HM. Intimate partner violence and contraception use among women in Sub-Saharan Africa. Int J Gynecol Obstet. 2009 (in press).

  42. Carey MP, Carey KB, Maisto SA, Gordon CM, Schroeder KEE, Vanable PA. Reducing HIV risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial. J Consult Clin Psychol. 2004;72:252–68.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was sponsored by NIAAA-funded R21AA016884, NIDA-funded P50DA09241 and supported in part by a grant to the USAID-AMPATH Partnership from the United States Agency for International Development as part of the President’s Emergency Plan for AIDS Relief. We acknowledge Emmanuel Wamalwa and Serah Chepseba for their assistance with data collection. We also thank Robert Skipworth Comer from the Indiana University School of Informatics for the contribution and development of locally relevant CBT illustrations. Finally, we extend our appreciation to Chematics, Inc. of North Webster, Indiana for the generous donation of alcohol saliva tests for this project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rebecca K. Papas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Papas, R.K., Sidle, J.E., Martino, S. et al. Systematic Cultural Adaptation of Cognitive-Behavioral Therapy to Reduce Alcohol Use Among HIV-Infected Outpatients in Western Kenya. AIDS Behav 14, 669–678 (2010). https://doi.org/10.1007/s10461-009-9647-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-009-9647-6

Keywords

Navigation