CETA-CORE

Unhealthy alcohol use is a major unaddressed barrier to control of the HIV epidemic in the region south of the Sahara Desert and the United States. The Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA) aims to address this barrier through the following overarching aims: (Aim 1) test the effectiveness of a transdiagnostic treatment model (Common Elements Treatment Approach [CETA]) to reduce unhealthy alcohol use and improve HIV clinical outcomes; (Aim 2) evaluate the mechanisms through which CETA impacts HIV outcomes; (Aim 3) investigate whether the treatment effect of CETA varies by clinical (e.g., presence of mental health comorbidities), demographic and contextual (e.g., Zambia, Alabama) factors; and (Aim 4) examine implementation factors, including cost, related to integrated delivery of alcohol reduction interventions to people with HIV and unhealthy alcohol use at front-line HIV clinics. The CETA Core will provide clinical oversight to ZAMBAMA’s two clinical trials and promote integration and synergy with the program. The Core’s specific aims are (a) train providers in CETA and an alcohol brief intervention in Zambia and Alabama, (b) provide continuous clinical supervision to the newly trained providers throughout the study periods, (c) evaluate the clinical competency, knowledge, and fidelity of newly trained providers and supervisors. The Core is led by the developers of CETA and the alcohol BI who have trained providers and used these interventions in the region south of the Sahara Desert and the U.S. CETA is a multi-problem, modular, cognitive behavioral therapy-based model that is delivered over 6-12 sessions and was found to be effective for a range of mental health symptoms, unhealthy alcohol use, and other substance use in several previous controlled clinical trials. Although developed to address severe gaps in the professional mental health workforce in low-income settings, CETA is increasingly used in the U.S. In ZAMBAMA’s two clinical trials, BI plus referral to CETA will be compared with BI alone for adults with HIV and unhealthy alcohol use at resource-limited clinics, and the program’s central hypothesis that screening and treatment of psychiatric comorbidities is critical to improving clinical outcomes in people with HIV and unhealthy alcohol use.