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Alcohol Epidemiology and Pilot Intervention to Reduce Alcohol, IPV and HIV in Women in Uganda

Funding Source: NIAAA grant K01-AA024068
 PI: Jennifer Wagman

This five-year NIAAA-funded Mentored Research Scientist Development Award (K01) will provide training and research experiences in the fields of alcohol use epidemiology, advanced statistical methods, and screening and brief interventions (SBI) to reduce harmful alcohol use in the context of HIV prevention. Training objectives are to develop knowledge of alcohol abuse and HIV clinic-based alcohol reduction intervention research and skills in categorical data and multivariate analysis and structural equation modeling using longitudinal data. The training will be supplemented with research to assess the magnitude of women’s alcohol use in the rural Rakai District of Uganda; and understand the bidirectional relationship between women’s experiences of intimate partner violence (IPV), use of alcohol and risk for HIV infection. Additionally, a pilot study will be conducted to test a SBI to reduce harmful alcohol use in abused women who are seeking HIV counseling and testing (HCT) from Rakai Health Sciences Program (RHSP), an HIV program in rural Uganda.

The specific aims for this research project are to:
  1. Estimate the prevalence and determinants of use of alcohol among women in Rakai.
  2. Longitudinally examine the temporal relationship between alcohol, IPV and HIV infection and elucidate the direction of these associations.
  3. Conduct qualitative research to identify barriers to and tailor an integrated alcohol and IPV reduction SBI into RHSP’s standard HCT model in a fishing community in Rakai.
  4. Implement an integrated alcohol and IPV reduction SBI for women residing in a fishing community in Rakai and pilot test its feasibility for a future randomized controlled trial.
This study will be conducted in partnership with Rakai Health Sciences Program. The foundational research (aims 1 and 2) will utilize quantitative data from the Rakai Community Cohort Study (RCCS), a 21-year HIV surveillance cohort that enrolls consenting residents in 54 Rakai District communities. RCCS is funded by two grants from NIAID (R01A110324; PI: Ronald Gray and R01AI114438; PI: Maria Wawer). The pilot test will be conducted as a 2-armed study with 80 women aged 15-49 years (40 intervention, 40 control) drawn from a fishing village where RCCS operates. Women who use alcohol, report being in an abusive relationship and seek post-test HIV counseling will be enrolled. Exposure will consist of a brief, integrated IPV and alcohol reduction intervention (intervention arm) vs. standard of HCT care (control participants). Data on alcohol use, IPV and HIV risk behaviors; and biological data on HIV status will be collected at baseline and 6 months; satisfaction with and appropriateness of the SBI will be measured at 6 months. Findings will determine feasibility of conducting this SBI in the Rakai setting and effect size needed to measure the intervention’s impact on alcohol use, IPV, HIV risk behaviors and HIV incidence.