Innovative strategies to promote biomedical HIV prevention uptake and retention among high-risk adults at drinking venues in Kenya and Uganda

Project Summary
HIV incidence remains unacceptably high in sub-Saharan Africa (SSA) due in part to inadequate access,
uptake, and retention in biomedical HIV prevention services, including pre- and post-exposure prophylaxis
(PrEP/PEP), among persons at increased HIV risk. Alcohol use is a common risk factor for both HIV
acquisition and poor HIV prevention uptake and retention in SSA. Interventions that promote biomedical HIV
prevention among persons with heavy alcohol use and their sexual partners are urgently needed.
Alcohol-serving drinking venues play an important role as sites of HIV transmission in SSA and are ideal sites
to engage women and men at increased risk of HIV in biomedical prevention services. However, despite long-
standing awareness of drinking venues as transmission “hot spots”, few interventions exist to reach and
engage persons in PrEP and PEP from drinking venues in SSA. Major barriers to reaching and engaging
persons at high risk of HIV from community settings such as drinking venues in HIV testing – a critical first step
to accessing biomedical HIV prevention – include HIV-associated stigma and poor perceptions of risk. To
address these barriers, we have developed a mobilization strategy of integrating HIV testing within multi-
disease screening to recruit >2,000 people from drinking venues in Kenya and Uganda, reaching >75% of
adults recruited for HIV testing. We now need to determine whether multi-disease mobilization can promote
uptake of HIV prevention for adults at drinking venues in the context of new biomedical prevention options.
Following uptake of biomedical HIV prevention, persons with heavy alcohol use face challenges with retention
in care and adherence to PrEP/PEP. We have adapted a brief alcohol counseling intervention (Health Living)
to reduce alcohol use and promote antiretroviral therapy (ART) adherence and HIV viral suppression among
persons with HIV in Kenya and Uganda. We now need to determine whether this intervention can promote
retention in biomedical prevention and PrEP/PEP adherence among adults with heavy alcohol use.
The project will rigorously test innovative interventions in Kenya and Uganda to increase uptake and use of
biomedical HIV prevention, and assess facilitators, barriers, and cost-effectiveness of these approaches.
The project will have the following aims: Aim 1: Compare the effectiveness of two mobilization strategies to
increase uptake of biomedical HIV prevention among adults at drinking venues. Aim 2: Determine the efficacy
of the Healthy Living Intervention (HLI) to reduce heavy alcohol use vs. standard care (control) on retention in
biomedical HIV prevention in a randomized trial among adults with heavy alcohol use. Aim 3: Determine the
cost-effectiveness of interventions that increase biomedical HIV prevention uptake (Aim 1) and retention (Aim
2) among adults at high-risk for HIV who attend drinking venues.
The proposed research will address the critical intersection of alcohol use and HIV risk in SSA, by promoting
reach, uptake and retention in biomedical HIV prevention and exploring associated facilitators and barriers.

Grant Number: 3R01AA030464-04S1
NIH Institute/Center: NIH
Principal Investigator: Gabriel Chamie