healthmedicinet

Location

The specific VCT site utilized in this study was chosen because it is the largest
in Katutura and is well known. As of August 2010, the site reported an average of
45 clients receiving VCT services at the center each day, six days a week, and 50 %
were male. Katutura is a large former township on the outskirts of the Namibian capitol,
Windhoek. Katutura was established for non-white residents prior to independence during
the apartheid era, however it now includes an ethnically diverse population of approximately
100,000–200,000 persons.

Participants

To be eligible to participate in the randomized controlled trial of the behavioral
counseling intervention, participants had to be men at least 18 years of age who tested
HIV-negative at a VCT site in Katutura, Namibia. Additional eligibility criteria included
self-report of harmful or hazardous alcohol consumption and more than one sexual partner
in the previous three months. Hazardous or harmful drinking was determined as having
a Alcohol Use Disorders Identification Test (AUDIT) score of eight to 19 (WHO defined
risk levels of harmful or hazardous drinking) 26]. Men had to be able to provide informed consent, have access to a cell phone, have
plans to stay in the area for six months, after the beginning of the trial, and be
able to communicate verbally in English, Oshiwambo, or Afrikaans.

Study methods

Study recruitment and follow up took place from February 2011 to April 2013. Men were
approached consecutively as they entered the VCT and asked if they would be willing
to participate in the study. Men were initially screened for eligibility based on
age, language, residency, alcohol consumption in the last month, HIV status, HIV test
day of screening, sexual partners in the last three months, possession of cell phone
(eligibility requirements described in more detail above). Men who passed the initial
screening were then screened for alcohol use using the AUDIT questions. Men who also
passed the alcohol screening were then given the consent form to review with screener.

A total of 8004 men were approached about the study; 7163 were screened (89.5 %) and
1243 (17.4 %) were found eligible. After a second round of eligibility screening,
a total of 573 (46.1 %) men were eligible to participate in the study based on the
criteria explained above. Written informed consent was obtained from the participants
prior to beginning data collection. The protocol was reviewed by the Namibian Ministry
of Health and Social Services Ethics Review Board and The Centers for Disease Control
Institutional Review Board and received final approval in December 2010. Due to administrator
error and miscommunication, the study was not registered at clinicaltrials.gov until
after study completion, although the study protocol was extensively reviewed by both
boards/committees prior to implementation. The present study includes all men in the
randomized controlled trial and presents baseline assessment data. For additional
details on intervention methodology, see clinicaltrials.gov.

All participants were given a study ID card with the dates for the three- and six-month
follow up appointments. After completion of the baseline assessment men received a
$7.00USD (N$50) grocery store voucher for their time. After each follow up appointment,
men were given taxi fare ($2.00USD) and a $7.00USD grocery store voucher for the time.

Measures

Sociodemographic and access to healthcare characteristics

Participants were asked about their current age, residential location, educational
attainment, employment status, marital status, children, and socioeconomic-related
questions.

Self-risk perception and exposure to HIV intervention and HIV knowledge

Participants were asked if a health care worker had ever talked with them about their
sex behaviors, their alcohol use or the connection between alcohol use and riskier
sex. The survey also assessed self-perceived HIV risk, condom use during sexual encounters,
and alcohol use before sexual encounters. Questions were asked about HIV knowledge,
including routes of transmission and treatment.

Alcohol use and alcohol-related knowledge

Alcohol-related knowledge included questions on physiological effects of heavy alcohol
use, impact of alcohol use on sexual function and ability to practice safe sex, coping
with daily stressors, and addiction. The AUDIT questionnaire, where total scores range
from 0 to 40, 27] was administered to determine eligibility. Men were categorized into 3 drinking categories:
non-drinkers (AUDIT?=?0), non-harmful drinkers (AUDIT?=?1–7), and harmful/likely dependent
drinkers (AUDIT???8). As mentioned previously, men were eligible to participate, if
they had scores from 8 to 19. In addition to the AUDIT, men were asked about types
of alcohol consumed. The 4-item CAGE alcohol screen also was embedded in the AUDIT
screen. The CAGE has been shown to be an accurate method of screening for problematic
alcohol usage patterns and a score of two or more is defined as being clinically significant
and an indication of alcohol problems 28]. The results of the CAGE and AUDIT screens were evaluated to determine if they identified
the same men as harmful or hazardous drinkers.

Condom use and sexual behavior history

Condom use, including frequency of use, partners with whom condoms were used, and
reasons for not using condoms were assessed. Sexual activity questions included a
detailed history for up to four sexual partners in the previous six months. Data collected
included partner sex, partner type, frequency of sexual activity, HIV and pregnancy
prevention, alcohol use related to sexual activity, including if the partner was initially
met at a drinking venue. Knowledge of partner HIV status and testing history were
also assessed.

Data analysis plan

Performed univariate analyses included frequencies, percentages, means, and standard
errors, where applicable. The analyses were conducted using SAS 9.3 and R 3.01.