Kenya Health Behavior Study

The Kenya Health Behavior Study is an experienced group of Kenyan and U.S. behavioral scientists, physicians, substance users in recovery and persons infected with HIV. KHBS expands on well-established ties between the Academic Model for Providing Access to Healthcare (AMPATH) and the Brown University Medical School, which has been an active AMPATH partner since 1997. AMPATH currently treats more than 75,000 HIV-infected patients in 25 clinics in western Kenya. This team completed a Stage 1 trial of a group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among 75 HIV-infected Kenyans. The project was funded by the National Institute of Alcohol Abuse and Alcoholism (R21AA017884). Results demonstrated feasibility, acceptability and estimated a large treatment effect at post-treatment. We now are conducting a large Stage 2 efficacy trial of the CBT alcohol intervention also funded by the National Institute of Alcohol Abuse and Alcoholism (R01AA020805). Our goal is to evaluate the efficacy of the Reduce Alcohol First in Kenya Intervention (RAFIKI) in its ability to reduce alcohol use within a larger Stage 2 trial that includes an active control and a longer follow-up period. Rafiki means “friend” in Kiswahili, the national language of Kenya. The trial is being conducted among up to 450 HIV-infected Kenyan outpatients who report hazardous or binge drinking. The RAFIKI trial will determine whether a group CBT intervention that demonstrates preliminary evidence of reducing alcohol use among HIV-infected outpatients in western Kenya is effective when compared against a group health education intervention with a 9-month follow-up period. It will be delivered by paraprofessionals, individuals with limited formal education and little or no relevant professional experience. This approach is consistent with successful cost-effective models of service delivery in resource-limited settings in which paraprofessionals (e.g., clinical officers, traditional birth attendants and peer counselors) are trained. The 5-6 year project started in September 2011 and will soon be in its 3^rd year.