# Reducing hazardous alcohol use and optimizing treatment as prevention among men living with HIV in risk environments

> **NIH NIH R01** · SAN DIEGO STATE UNIVERSITY · 2024 · $772,055

## Abstract

PROJECT SUMMARY
Heavy and hazardous alcohol use is inextricably linked to the HIV epidemic in fishing communities on Lake
Victoria in Uganda. Among men living with HIV (LWH) in fishing communities, hazardous alcohol use is
associated with suboptimal antiretroviral (ART) adherence and engagement in HIV care. Fishing communities
are “risk environments'' with limited access to health services and norms reinforcing risky behavior. Contextually
appropriate evidence-based interventions that address these issues in tandem among men LWH in fishing
communities are urgently needed to ensure optimization of treatment as prevention. We developed Kisoboka (“It
is Possible'') a behavioral intervention with a structural element to “reduce cash in the pocket" otherwise easily
accessible for alcohol purchase. Kisoboka utilizes a behavioral economics (BE) approach and motivational
interviewing (MI) to reduce hazardous drinking and improve ART adherence to achieve undetectable HIV viral
load (VL). In the pilot RCT of the Kisoboka intervention, it demonstrated preliminary efficacy in reducing AUDIT-
C scores and phosphatidylethanol (PEth) levels among the very hazardously drinking sample and a protective
effect on ART adherence through 6-month follow-up. To inform future scale-up, we propose a factorial RCT
(n=716) to test intervention efficacy and determine if effects are attributable to specific intervention components.
Specific aims are: (1) Determine the efficacy of the Kisoboka intervention and its components among
hazardously drinking men LWH in Uganda in a 2x2 factorial RCT. Arm 1: The Kisoboka intervention (BE+MI);
Arm 2: the behavioral economic component of Kisoboka (BE); Arm 3: the MI-based alcohol reduction and ART
adherence counseling component of Kisoboka (MI); and Arm 4: alcohol screening, referral, and brief intervention.
Primary outcomes assessed at baseline, 6-, and 12-month follow-up include: PEth (alcohol biomarker), a
combined AUDIT-C score—PEth outcome for hazardous drinking, HIV viral load, and ART adherence via
biomarker. (2) Assess the impact of the Kisoboka intervention and its components on measures of psychological,
physical, and socioeconomic well-being that capture frequent comorbidities of persons LWH and that are
associated with achieving successful treatment as prevention. (3) Guided by the Exploration, Preparation,
Implementation and Sustainment framework, engage key health sector stakeholders to understand barriers and
facilitators in the inner and outer context and assess intervention and implementation costs for implementing
Kisoboka components within the routine clinical setting to inform future widespread implementation. If effective,
Kisoboka, or its components, will be poised for dissemination and scale-up, supporting treatment as prevention
goals among a high-risk population and as one of a limited number of evidence-based HIV alcohol interventions
in this setting.

## Key facts

- **NIH application ID:** 10924902
- **Project number:** 1R01AA031650-01
- **Recipient organization:** SAN DIEGO STATE UNIVERSITY
- **Principal Investigator:** Susan Maria Kiene
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $772,055
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10924902

## Citation

> US National Institutes of Health, RePORTER application 10924902, Reducing hazardous alcohol use and optimizing treatment as prevention among men living with HIV in risk environments (1R01AA031650-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10924902. Licensed CC0.

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