# Enhancing HIV prevention and reducing alcohol use among people receiving STI care in Malawi: An HIV status neutral approach

> **NIH NIH R34** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $203,981

## Abstract

PROJECT SUMMARY
HIV continues to be a significant public health problem throughout sub-Saharan Africa, including in Malawi.
Sexually transmitted infection (STI) care settings are underutilized venues to simultaneously reach virally
unsuppressed people with HIV (PWH) and those at high risk of HIV and have the potential to optimize HIV
prevention and treatment outcomes. Hazardous alcohol use is widespread in Malawi and among people
receiving STI care and is a critical barrier to the success of HIV prevention efforts. TrEAT is a brief, highly
effective, culturally appropriate, scalable, evidence-based intervention (EBI) for alcohol reduction. While
culturally appropriate for diverse settings, TrEAT has not been adapted for the shifting HIV care environment
that includes both PWH and people at high risk for HIV. Through preliminary work, our team has demonstrated
that: 1) Hazardous alcohol use is highly prevalent among people receiving STI care in SSA, including Malawi;
2) TrEAT is culturally appropriate, feasibile, acceptable, and effective at reducing alcohol use and improving
viral suppression among PWH across global settings, including in SSA; and 3) Successfully led alcohol
reduction and HIV prevention and treatment effectiveness and implementation studies. The overall goal for this
R34 application is to produce a culturally adapted, scalable HIV ‘status-neutral’ EBI for alcohol reduction and
HIV prevention and treatment optimization to test in an R01 hybrid effectiveness-implementation trial. We will
conduct a 2-arm pilot randomized controlled trial (RCT) comparing TrEAT4All to usual care to assess the
preliminary efficacy and implementation of HIV prevention and treatment within one STI care setting which
serves as an early Pre-exposure Prophylaxis (PrEP) implementation site in Lilongwe, Malawi. Drawing from
our previous manualized interventions, we will develop a 3-session intervention, TrEAT4All, that integrates HIV
prevention and treatment counseling into TrEAT to improve HIV prevention outcomes—PrEP use for those
who are at risk for HIV and viral suppression for PWH. Our specific aims are to 1) Adapt TrEAT, an EBI for
alcohol reduction, to integrate HIV status-neutral counseling (TrEAT4All) for PWH and those at high risk of HIV
who report heavy drinking and are receiving STI care in Malawi; 2) Evaluate short-term efficacy and
implementation of TrEAT4All for optimizing HIV prevention and treatment outcomes (viral suppression among
PWH; PrEP use among those at high risk of HIV) and proportion of heavy drinking days in past 30 days; and 3)
Explore pathways of TrEAT4All responsiveness among intervention participants. Results will have relevance
for integrating alcohol reduction EBIs into real-world STI care settings to optimize HIV prevention and
treatment programs throughout sub-Saharan Africa and other regions where alcohol plays a role in HIV
spread.

## Key facts

- **NIH application ID:** 10877785
- **Project number:** 5R34AA030939-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Kathryn Elizabeth Lancaster
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $203,981
- **Award type:** 5
- **Project period:** 2023-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10877785

## Citation

> US National Institutes of Health, RePORTER application 10877785, Enhancing HIV prevention and reducing alcohol use among people receiving STI care in Malawi: An HIV status neutral approach (5R34AA030939-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10877785. Licensed CC0.

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