This study was funded by NICHD grant number R01HD058320

1. Results of a Brief Intervention for Reducing Alcohol Use among HIV Positive Women in Cape Town, South Africa William Zule,1Irene Doherty,1Bronwyn Meyers,2Felicia Browne,3 Tara Carney,2 Charles Parry,2 Wendee Wechsberg1 1RTI International, Research Triangle Park, NC, USA 2Medical Research Council, Cape Town, South Africa 3Harvard University School of Public Health, Cambridge, MA, USA This study was funded by NICHD grant number R01HD058320

2. Background • Alcohol use is linked to sex risk behaviors • Alcohol use may decrease adherence to antiretroviral therapy • In models “HIV treatment as prevention” has the potential for ending the HIV epidemic • 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 St. Petersburg, Russia(2006 – 2009) Republic of Georgia (2010 to present) IDU Women NIDA Pretoria, SA (2001 – 2008) (2011 to present) Sex workers and vulnerable women NIDA and NIAAA Cape Town , SA (2003 – present) NIDA, NICHD and NIAAA

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

5. Overview of Women’s Health CoOpIntervention Goal: Decrease sexual risk, AOD use and violence in women’s lives

6. Study Design

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

8. Main Study Participant Characteristics (N=720) • Enrollment • Women’s : 360 • Nutrition : 181 • VCT only : 179 12M Follow-Up Rate 83%

9. Main Study Drug Use by Intervention Arm Baseline Biological Drug Test Results at Baseline I

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

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

12. Abstinence from Alcohol at 12-month Followup

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

14. Model of Drug Use Outcomes at 12-month Followup

15. Conclusions • 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. 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. Implications • 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.