# Interventions to reduce alcohol use and increase adherence to TB preventive therapy among HIV/TB co-infected drinkers (DIPT 2/2)

> **NIH NIH U01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $523,405

## Abstract

ABSTRACT
TB is the leading cause of death among persons with HIV worldwide. Globally, approximately 25% of persons
with HIV are heavy drinkers, and heavy alcohol use is associated with a 3-fold higher risk of TB disease
compared to no alcohol use, thus HIV-infected persons who drink alcohol are at high risk for TB. Six months of
isoniazid (INH) preventive therapy (IPT) reduces TB incidence and mortality by 30-50% above the positive
impact of antiretroviral therapy (ART). However, INH can be toxic to the liver, and thus many heavy alcohol
users in resource-limited settings such as east Africa are not offered IPT. In addition, heavy alcohol users have
poorer ART adherence and data suggest decreased IPT adherence as well. Thus interventions are needed to
both decrease alcohol use and increase IPT adherence, and thereby reduce INH toxicity, TB morbidity and
mortality in this high-risk population. The use of incentives to promote healthy behavior has been shown to be
a highly effective approach for reducing substance use and for improving adherence to HIV and TB regimens
in high-income countries. Reducing alcohol use may create a window for safe and effective IPT use by
decreasing hepatotoxicity and increasing IPT adherence; however, additional interventions for IPT adherence
may be needed. The use of incentives conditional on reduced alcohol use or increased INH adherence in
resource-limited settings has been previously limited by the lack of reliable, rapid tests for these behaviors.
Recent technological advances allow for point of care (POC) urine testing for recent alcohol use with an ethyl
glucuronide (EtG) dipstick that is positive for 3 days after heavy drinking, and INH pill-taking using the
IsoScreen urine test to test for 24-hour INH ingestion, thereby creating an opportunity to test incentive-based
interventions during IPT among heavy drinkers. We propose leveraging two established cohorts of persons
with HIV in Uganda for a randomized 2x2 factorial trial among HIV/TB co-infected adults with heavy alcohol
use (n=800 persons. 400 each U01 cohort). Aim 1 is to determine whether economic incentives contingent on
reduced alcohol use assessed by POC EtG tests conducted at INH refill visits reduces heavy alcohol use over
six months of IPT compared to the control. Aim 2 is to determine whether economic incentives contingent on
INH positive POC urine tests at these visits compared to the control increases IPT adherence over six months.
Aim 3 is to examine the longer-term impact of the intervention on HIV virologic suppression, and examine
mediators of an effect. Primary outcomes will be self-reported heavy alcohol use augmented by
phosphatidylethanol (PEth) concentrations, and INH adherence, measured using medication event monitoring
system (MEMS), with additional measurements of pill ingestion by INH levels in hair samples. Using incentive-
based interventions to reduce alcohol use and increase medication safety in low-income settings is novel. Th...

## Key facts

- **NIH application ID:** 9997767
- **Project number:** 5U01AA026221-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Gabriel Chamie
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $523,405
- **Award type:** 5
- **Project period:** 2017-09-15 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9997767

## Citation

> US National Institutes of Health, RePORTER application 9997767, Interventions to reduce alcohol use and increase adherence to TB preventive therapy among HIV/TB co-infected drinkers (DIPT 2/2) (5U01AA026221-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9997767. Licensed CC0.

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