Project Summary/Abstract (Original Proposal) In sub-Saharan Africa (SSA), our research suggests that primary partners should be involved in alcohol interventions given their critical role in helping drinkers reduce alcohol use and the couple dynamics that intersect with alcohol use. Motivational interviewing (MI) is a proven intervention for reducing alcohol use among individuals living with HIV, and emerging evidence suggests that MI is a promising option for couples. Correct knowledge of drinking levels in real-time is critical for triggering couple communication and timely and tailored support to help drinkers reduce their alcohol use. Mobile breathalyzer technology could help to achieve this goal by providing real-time and objective feedback to couples and current apps already have this built-in dyadic functionality. In this study, we propose to develop and test an alcohol intervention using couple-based MI and mobile breathalyzers to build dyadic support around drinking in HIV-affected couples in South Africa. We posit that by motivating the couple to work together to reduce drinking, and using mobile breathalyzers as a tool to increase partner knowledge and trigger couple communication and timely support, we will reduce heavy alcohol use and improve HIV treatment outcomes. The specific aims are to: (1) to adapt a couple-based MI intervention to reduce alcohol use in HIV-affected South African couples and incorporate a breathalyzer with mobile app to deliver real-time feedback on blood alcohol content (BAC) levels to both partners; (2) to develop and pilot test the study procedures for a future randomized controlled trial (RCT) of the couple-based intervention; and (3) to assess the feasibility and acceptability (F&A) of a couple-based MI intervention with and without mobile breathalyzers for real-time feedback. For Aim 1, we will adapt a couple-based MI framework and interventions (We Test and the Couples Health Project) to address alcohol use in South African couples and incorporate the breathalyzer component. For Aim 2, we will develop the intervention manuals, study procedures, and data collection instruments to be pilot tested. For Aim 3, we will implement a three-arm RCT with 30 couples randomized to the following arms (90 couples total): 1) an enhanced usual care control condition; 2) couple-based MI; and 3) couple-based MI with mobile breathalyzers for feedback. For arm 2 and 3, couples will receive several monthly MI sessions with a lay counselor to help couples strengthen communication and problem-solving skills around alcohol use. For Arm 3, couples will use the mobile breathalyzers and app for 60 days and receive the same MI sessions, which will also incorporate feedback on BAC levels (prior 30 days) and teach couples how to effectively engage with the breathalyzers. We will conduct exit interviews with a subset of 30 couples to contextualize F&A data, and will analyze the mixed-methods data to refine the intervention for a future efficacy trial. Our long-term goal is to implement a couple-based MI intervention that leverages the mobile breathalyzer technology for real-time feedback and support, and can be scaled-up to reduce alcohol use, strengthen couple support, and improve HIV treatment outcomes in SSA.

Project Narrative (Original Proposal) This project aims to develop and test an alcohol intervention using couple-based MI and mobile breathalyzers to build dyadic support around drinking in HIV-affected couples in South Africa. Our goal is to demonstrate a proof-of-concept for the proposed intervention, which if shown to be feasible and acceptable, may provide a scalable intervention to reduce heavy alcohol consumption and improve HIV treatment outcomes for couples in sub-Saharan Africa.