Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

Jennifer M Belus; John A Joska; Yosef Bronsteyn; Alexandra L Rose; Lena S Andersen; Kristen S Regenauer; Bronwyn Myers; Judith A Hahn; Catherine Orrell; Steve A Safren; Jessica F Magidson

doi:10.1007/s10461-022-03765-8

Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

AIDS Behav. 2022 Nov;26(11):3630-3641. doi: 10.1007/s10461-022-03765-8. Epub 2022 Jul 27.

Authors

Jennifer M Belus^{1

2

3}, John A Joska⁴, Yosef Bronsteyn⁵, Alexandra L Rose⁵, Lena S Andersen⁶, Kristen S Regenauer⁵, Bronwyn Myers^{7

8

9}, Judith A Hahn¹⁰, Catherine Orrell¹¹, Steve A Safren¹², Jessica F Magidson⁵

Affiliations

¹ Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland. jennifer.belus@unibas.ch.
² University of Basel, Basel, Switzerland. jennifer.belus@unibas.ch.
³ Department of Psychology, University of Maryland, College Park, MD, USA. jennifer.belus@unibas.ch.
⁴ HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁵ Department of Psychology, University of Maryland, College Park, MD, USA.
⁶ Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁷ Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
⁸ South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa.
⁹ Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
¹⁰ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹¹ Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
¹² Department of Psychology, University of Miami, Miami, FL, USA.

Abstract

Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD.Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

Keywords: ART adherence; Behavioral intervention; Gender differences; South Africa; Substance use.

Publication types

Randomized Controlled Trial

MeSH terms

Anti-Retroviral Agents / therapeutic use
Female
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Male
Medication Adherence
South Africa / epidemiology
Substance-Related Disorders* / complications
Substance-Related Disorders* / epidemiology

Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Associated data

Grants and funding