An interventional study of Brief Intervention and Common Elements Treatment Approach (CETA) in Alcohol Use Disorder, Depression and Post-traumatic Stress Disorder, sponsored by Columbia University. Terminated at 1 site in Zambia. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-09-23.
Sponsored by Columbia University · Not applicable, Interventional, and Treatment
This is a randomized controlled trial (RCT) evaluating the effectiveness of an alcohol brief intervention alone compared to the brief intervention plus an evidence-based psychotherapy (CETA) in reducing alcohol misuse and co-occurring mental health problems among persons with HIV in Zambia.
Alcohol misuse is a major unaddressed barrier to ending the HIV/AIDS epidemic. Hazardous drinking increases HIV transmission, delays antiretroviral therapy (ART) uptake, reduces adherence and retention, and increases mortality. Comorbid mental health or substance misuse, similar to alcohol use alone, can also significantly undermine HIV treatment. The vast majority of people living with HIV globally live in low- and middle-income countries (LMIC). Similar to most HIV care settings in LMIC, in Zambia, the location of the current study, there are no readily available evidence-based treatments for alcohol misuse or mental health problems.
This study will enroll persons living with HIV (PLWH) who have alcohol misuse in Zambia. Participants will be recruited and screened during regular HIV care visits. Participants will be recruited by their regular care providers (i.e., peer educators, counselors, nurses, physicians) and referred to study staff if they are interested. The investigators anticipate enrolling up to 320 participants, all of whom have hazardous alcohol use. N=160 participants will be high-risk drinkers due to having either a moderate-to-severe alcohol use disorder or mental health comorbidities, or both. These participants will be randomized into the RCT. Participants who have hazardous alcohol use (but not a moderate-to-severe AUD) without mental health comorbidities (a lower risk group of participants) will not be enrolled into the RCT but will be tracked as part of a parallel cohort study. The minimum age of research subjects will be 18. Eligibility will be assessed via audio computer assisted self-interviewing (ACASI).
Participants in the 'cohort study' (i.e., lower risk participants) will receive a brief alcohol intervention. Participants in the RCT (i.e., higher risk participants) will be randomly assigned on a 1:1 basis (stratified by gender) to receive the brief intervention alone or the brief intervention plus CETA.
All participants will be evaluated for outcomes at baseline and at a six month follow-up visit. For RCT participants, the investigators will compare the effectiveness of the brief intervention alone to the brief intervention plus CETA in reducing alcohol misuse and mental health problems. For cohort participants, the investigators will collect preliminary data on whether alcohol misuse reduced at the six month follow-up but there will be no comparison/control group.
The findings from this pilot study will be used to inform future programming and research in Zambia and other LMIC to implement screening, brief intervention, and referral to treatment (SBIRT) programs for alcohol use in HIV care.
2,124 studies on the registry are indexed under Substance-Related Disorders; 393 are open to participants now.
This study's enrollment of 160 is above the median of 108 across 1,727 interventional studies indexed under Substance-Related Disorders.
Browse Substance-Related Disorders studies →Columbia University is the lead sponsor of 1,103 studies on the registry; 193 are open to participants now.
Of its 172 completed or terminated interventional studies of FDA-regulated products, 142 (83%) have results posted.
Counted across the registry records on this site, refreshed daily.
Initial inclusion criteria for overall enrollment (into either the Cohort or RCT study) will be:
Secondary inclusion for enrollment into the RCT will be:
Exclusion Criteria:
30 minute alcohol brief intervention delivered by lay provider during HIV clinic visit.
Behavioral: Brief Intervention
30 minute alcohol brief intervention delivered by lay provider during clinic visit followed by 6-12 weekly sessions of CETA.
Behavioral: Brief Intervention · Behavioral: Common Elements Treatment Approach (CETA)
The BI used in the trial combines motivational interviewing skills with cognitive behavioral therapy elements in order to assist clients with self identified substance misuse to begin to consider changing their rates of drinking and drug use. The intervention lasts 30 to 40 minutes and consists of 5 components including: 1) screening 2) identification and information on the impacts of substance misuse 3) talking about change and goal setting 4) understanding the primary reason for drinking 5) skill building with practice and 6) referral for services.
The Common Elements Treatment Approach, or CETA, is a transdiagnostic psychotherapy based on cognitive behavioral elements for mood, anxiety and trauma related problems, and for alcohol and substance misuse. CETA is based on the fact that most evidence-based mental health treatments (EBTs) consist of similar components. The objective of CETA is to provide a single training in a range of therapy components that are similar across EBTs and to then teach counselors how to design a specific course of treatment for each client based on the client's presenting problems.
Change in Alcohol Use Disorders Identification Test (AUDIT) Scale Score From Baseline to 6-month Post-baseline.
AUDIT is a 10-item measure of hazardous alcohol use with possible range of 0-40 (total scale score). Higher scores are associated with more hazardous use.
Time frame: Baseline and 6 months post-baseline
Change in Center for Epidemiological Studies-Depression (CES-D) Scale Score From Baseline to 6-month Post-baseline.
CES-D is a 20-item scale of depression with a possible range of 0-60 (total scale score). Higher scores are associated with greater depression symptom severity.
Time frame: Baseline and 6 months post-baseline
Change in Harvard Trauma Questionnaire (HTQ) Post-traumatic Stress Disorder (PTSD) Symptom Scale Score From Baseline to 6-month Post-baseline.
The HTQ is a 39-item PTSD symptom scale with possible range of 1-4 (average scale score). Higher scores are associated with greater PTSD symptom severity.
Time frame: Baseline and 6 months post-baseline
Number of Participants With Any Recent Substance Use.
Any recent substance use will be defined as any use of the following substance types in the past 3 months: inhalants, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opioids.
Time frame: 6 months post-baseline
| Milestone | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| Started | 78 | 82 |
| Completed | 56 | 62 |
| Not completed | 22 | 20 |
| Withdrew: Death | 1 | 0 |
| Withdrew: Lost to follow-up | 1 | 2 |
| Withdrew: Not post-assessed. study ended early due to covid-19 | 20 | 16 |
| Withdrew: Moved from study area. | 0 | 2 |
AUDIT is a 10-item measure of hazardous alcohol use with possible range of 0-40 (total scale score). Higher scores are associated with more hazardous use.
| Score on a scale | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| Change in Alcohol Use Disorders Identification Test (AUDIT) Scale Score From Baseline to 6-month Post-baseline. | -10.5 (-12.8 to -8.3) | -13.7 (-15.8 to -11.6) |
CES-D is a 20-item scale of depression with a possible range of 0-60 (total scale score). Higher scores are associated with greater depression symptom severity.
| Score on a scale | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| Change in Center for Epidemiological Studies-Depression (CES-D) Scale Score From Baseline to 6-month Post-baseline. | -4.2 (-7.2 to -1.1) | -8.9 (-11.8 to -6.0) |
The HTQ is a 39-item PTSD symptom scale with possible range of 1-4 (average scale score). Higher scores are associated with greater PTSD symptom severity.
| Score on a scale | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| Change in Harvard Trauma Questionnaire (HTQ) Post-traumatic Stress Disorder (PTSD) Symptom Scale Score From Baseline to 6-month Post-baseline. | -0.3 (-0.5 to -0.1) | -0.5 (-0.7 to -0.4) |
Any recent substance use will be defined as any use of the following substance types in the past 3 months: inhalants, marijuana, cocaine, amphetamines, sedatives, hallucinogens, opioids.
| Participants | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| Number of Participants With Any Recent Substance Use. | 14 | 16 |
Collected over 6 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Brief Intervention (BI) | 1/78 (1.3%) | 1/78 (1.3%) | 0/78 (0%) |
| Brief Intervention + CETA | 0/82 (0%) | 0/82 (0%) | 0/82 (0%) |
| Event | Brief Intervention (BI) | Brief Intervention + CETA |
|---|---|---|
| AnemiaBlood and lymphatic system disorders | 1/78 | 0/82 |
| Age, Continuous(Years) | Brief Intervention (BI) | Brief Intervention + CETA | Total |
|---|---|---|---|
| Mean | 41.8 ± 9 | 38.6 ± 9.4 | 40.2 ± 9.3 |
| Sex: Female, Male(Participants) | Brief Intervention (BI) | Brief Intervention + CETA | Total |
|---|---|---|---|
| Female | 34 | 36 | 70 |
| Male | 44 | 46 | 90 |
| Race (NIH/OMB)(Participants) | Brief Intervention (BI) | Brief Intervention + CETA | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 78 | 82 | 160 |
| White | 0 | 0 | 0 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(participants) | Brief Intervention (BI) | Brief Intervention + CETA | Total |
|---|---|---|---|
| Zambia | 78 | 82 | 160 |
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