Combination prevention for women who use alcohol in South Africa

Abstract

Poster Discussion Abstracts WEPDC0204 Background: Women who use substances, are at heightened risk for HIV but have been largely ignored by HIV primary and secondary pre-vention efforts. They are also more likely to experience gender-based violence (GBV) and sexual risk, with many reporting sex work –increasing their HIV risk and decreasing their access to HIV care and antiretroviral (ARV) adherence. The purpose of this study was to determine the efficacy of voluntary HIV counseling and testing (HCT) compared to the Women’s Health CoOp (WHC+; 2 sessions) a gender focused prevention package to reduce substance use, GBV, sexual risk, and increase linkage to HIV care and adherence for women; hypothe-sizing that the WHC+ will report less substance use, GBV, sexual risk and more ARV adherence. Methods: This NIH cluster randomized trial recruited 641 Black Afri-can women (Mean age = 29.9 SD = 0.31 from 2013 to 2016) across the 14 geographic zones in Pretoria. Women completed interviews, drug, alcohol, pregnancy and HIV screening at baseline, 6- and 12-months in both arms with over 90% follow-up. CD4 tests were added to assist clinical staging in linkage to local clinics. Dried blood spots were obtained for viral load (VL) testing from a subset of women who were HIV positive. Results: Over 90% of women completed the study. Multiple and logistic regression using robust standard errors to account for cluster-ing at the zone level and controlling for sex work and HIV status revealed that women in the WHC+ arm were less likely to report fre-quent heavy drinking (p < 0.001); physical beating by boyfriend (p < 0.001); and reported more protected condom use (p < 0.03) with main partner at 6-month follow-up compared to those in the HCT arm. Of those linked to HIV treatment, 81% of participants in the WHC+ arm reported adhering to their ARVs compared to 65% of par-ticipants in the HCT arm (p = 0.07). There was a relationship between reduced heaving drinking and ARV adherence. Conclusions: The WHC+ combination prevention was found effica-cious reducing intersecting risks, linking women who tested HIV+ to care and helping with adherence. It could have further impact with booster sessions after six months with larger implementation.