1. Results of a Brief Intervention for Reducing Alcohol Use among HIV Positive Women in Cape Town, South Africa This study was funded by NICHD grant number R01HD058320 William Zule, 1 Irene Doherty, 1 Bronwyn Meyers, 2 Felicia Browne, 3 Tara Carney, 2 Charles Parry, 2 Wendee Wechsberg 1 1 RTI International, Research Triangle Park, NC, USA 2 Medical Research Council, Cape Town, South Africa 3 Harvard University School of Public Health, Cambridge, MA, USA

2. Background n Alcohol use is linked to sex risk behaviors n Alcohol use may decrease adherence to antiretroviral therapy n In models “HIV treatment as prevention” has the potential for ending the HIV epidemic n Interventions to reduce alcohol use among people living with HIV are essential to this effort

3. EBI Women’s CoOp Adaptations N.C., U.S. (1998 – present) Women’s CoOp 1, 2 and Pregnant Women’s CoOp Young Women’s CoOp NIDA and CDC Cape Town, SA (2003 – present) NIDA, NICHD and NIAAA Pretoria, SA (2001 – 2008) (2011 to present) Sex workers and vulnerable women NIDA and NIAAA St. Petersburg, Russia (2006 – 2009) Republic of Georgia (2010 to present) IDU Women NIDA

4. Outreach Efforts Weighted Across 15 Townships and Communities Cape Town in the Western Cape Province

5. Theoretical basesBlack feminist theory; empowerment theory Key intervention characteristics and core elements woman-focused cue cards; role-playing and rehearsal, including condom demonstration and practice; individualized risk assessment and action plan; and active referrals to community resources Target Populationfemale substance-using women from Cape Town communities Delivery methodsIn person DeliverersSouth African women (Black and Colored) who were trained to deliver the intervention Unit of delivery2 group sessions Goal: Decrease sexual risk, AOD use and violence in women’s lives Overview of Women’s Health CoOp Intervention

6. Study Design

7. Eligibility Criteria for Main Study n female n age 18–33 years n used at least two drugs (one of which could be alcohol) at least once a week for the past 3 months n sexually active with a man in the past month n living in one of the target communities,

8. Demographic Information (Baseline) Women’s CoOp Comparison Arms Age [M(SD)]22.3 (4.1)23.8 (4.3) Have Main Partner100%92% ≤ Grade 1183%94% Ever Physically Abused 36%83% Ever Raped12%32% HIV + (confirmatory ) 37%7% Enrollment Women’s : 360 Nutrition : 181 VCT only : 179 Main Study Participant Characteristics (N=720) 12M Follow-Up Rate 83%

9. Main Study Drug Use by Intervention Arm Baseline Biological Drug Test Results at Baseline Women’s Arm N= 324 Comparison Arms N = 396 Methamphetamine (Tik) # 45%49% Mandrax # 29%21% Opiates *8%6% I

10. HIV positive Self-report of alcohol use at baseline Additional Criteria for Inclusion in Current Analyses (n = 84 )

11. Abstinence from Alcohol at 12- month Followup by Intervention Arm

12. Logistic regressions model for abstinence from alcohol at 12-month followup a CoefficientOdds ratio (95% C.I.)p-value 1.283.61 (1.23- 11.70)0.016 a Adjusted for level of alcohol use at baseline Abstinence from Alcohol at 12- month Followup

13. Negative Urine Drug Screen Results for Opiates, Cocaine, Methamphetamine and Methaqualone by Intervention Arm

14. Logistic regression of negative test results for opiates, cocaine, methamphetamine, and methaqualone CoefficientOdds ratio (95% C.I.)p-value 1.123.07 (0.83-12.31)0.105 b adjusted for number of drugs positive for at baseline Model of Drug Use Outcomes at 12-month Followup

15. In previous analyses of the whole sample, this intervention was efficacious in increasing abstinence from AOD (Wechsberg et al., 2013). In subgroup analyses of HIV positive drinkers the intervention was efficacious in increasing abstinence from alcohol. Conclusions Wechsberg, W.M., et al. "A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women’s Health CoOp." BMJ Open 3.5 (2013)

16. HIV “treatment as prevention” requires achieving high levels of retention and medication adherence among high risk populations living with HIV As we engage more high risk populations, comorbid AOD use will become a critical barrier to retention and adherence that may prevent “treatment as prevention” from fulfilling its promise. Implications