1. Financial incentives for reduced alcohol use and increased isoniazid adherence during tuberculosis preventive therapy among people with HIV in Uganda: an open-label, factorial randomised controlled trial
- Author
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Chamie, Gabriel, Hahn, Judith A, Kekibiina, Allen, Emenyonu, Nneka I, Beesiga, Brian, Marson, Kara, Fatch, Robin, Lodi, Sara, Adong, Julian, Thirumurthy, Harsha, McDonell, Michael G, Gandhi, Monica, Bryant, Kendall, Havlir, Diane V, Kamya, Moses R, and Muyindike, Winnie R
- Subjects
Epidemiology ,Health Services and Systems ,Public Health ,Health Sciences ,Alcoholism ,Alcohol Use and Health ,Clinical Research ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,Substance Misuse ,Prevention ,HIV/AIDS ,Infectious Diseases ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Mental health ,Infection ,Good Health and Well Being ,Adult ,Humans ,Male ,Female ,Adolescent ,Middle Aged ,Isoniazid ,Motivation ,Uganda ,Alcoholism ,Treatment Outcome ,Tuberculosis ,HIV Infections ,Ethanol ,Biomarkers ,Microbiology ,Public Health and Health Services ,Health services and systems ,Public health - Abstract
BackgroundAlcohol use is common among people with HIV and is a risk factor for tuberculosis disease and non-adherence to isoniazid preventive therapy (IPT). Few interventions exist to reduce alcohol use and increase IPT adherence in sub-Saharan Africa. The aim of this study was to test the hypothesis that financial incentives conditional on point-of-care negative urine alcohol biomarker testing and positive urine isoniazid testing would reduce alcohol use and increase isoniazid adherence, respectively, in people with HIV who have latent tuberculosis infection and hazardous alcohol use.MethodsWe conducted an open-label, 2×2 factorial randomised controlled trial in Uganda. Eligible for the study were non-pregnant HIV-positive adults (aged ≥18 years) prescribed antiretroviral therapy for at least 6 months, with current heavy alcohol use confirmed by urine ethyl glucuronide (biomarker of recent alcohol use) and a positive Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; ≥3 for women, ≥4 for men) for the past 3 months' drinking, no history of active tuberculosis, tuberculosis treatment, or tuberculosis preventive therapy, and a positive tuberculin skin test. We randomly assigned participants (1:1:1:1) initiating 6 months of IPT to: no incentives (group 1); or incentives for recent alcohol abstinence (group 2), isoniazid adherence (group 3), or both (group 4). Escalating incentives were contingent on monthly point-of-care urine tests negative for ethyl glucuronide (groups 2 and 4), or positive on IsoScreen (biomarker of recent isoniazid use; groups 3 and 4). The primary alcohol outcome was non-hazardous use by self-report (AUDIT-C
- Published
- 2023