Utilizing Implementation Research Methodologies to Adapt an Intervention to Reduce Alcohol Use and Improve HIV Care Outcomes among Men Living with HIV who have Serodiscordant Pregnant Partners

PROJECT SUMMARY Hazardous alcohol use is prevalent among men living with HIV (MLWH) in Uganda and associated with non- adherence to antiretroviral therapy (ART) and detectable viral load (VL). This is especially problematic in serodiscordant partnerships with pregnant partners as HIV acquisition risk may increase by more than two-fold

during pregnancy and postpartum and incident HIV during this period also increases risk of vertical transmission due to high maternal viral load during the acute phase of infection. Therefore, intervening on alcohol use and ART adherence among MLWH with serodiscordant pregnant partners has the potential for tremendous public

health impact. To address the lack of evidence-based interventions (EBI) addressing alcohol use and HIV among MLWH in Uganda, we developed, Kisoboka, a behavioral and structural intervention grounded in motivational interviewing techniques and behavioral economics. The objective of this proposal is to adapt Kisoboka among

MLWH who engage in hazardous alcohol use with serodiscordant pregnant partners with the aim of extending intervention reach to reduce risk of HIV acquisition in pregnancy. Candidate: I am a public health researcher with 13-years of experience conducting HIV and alcohol use research in sub-Saharan Africa. I am applying for

a five-year K01 award to obtain the training, mentorship, and applied research experience needed to apply for an R01 and become an independently funded public health researcher. Training: Under mentorship of Drs. Susan Kiene (co-primary mentor, SDSU), Gregory Aarons (co-primary mentor, UCSD), Dvora Joseph Davey

(co-mentor, UCLA) and Judith Hahn (co-mentor, UCSF), this award will allow me to expand my capacity as a researcher by supporting advanced training in (1) implementation science (IS), (2) conduct of intervention research, (3) use of alcohol biomarkers and biofeedback counseling, and (4) collaboratively working in global

health settings. These training areas represent critical gaps in my skillset that will support my ability to ultimately lead the implementation, evaluation and scale-up of culturally and contextually relevant EBIs to address the syndemic of alcohol use and HIV. Research: specific aims: (1) Engage key stakeholders to co-adapt Kisoboka

for use with MLWH and their serodiscordant pregnant partners, (2) Use theater testing and iterative feedback from multilevel stakeholders to refine the adapted intervention (3) Conduct a pilot randomized control trial (RCT) in MLWH who use alcohol and have serodiscordant pregnant partners. With this award, I will strengthen my

capacity to rigorously conduct IS and intervention research, expedite the research pipeline and close the “know- do” research gap on addressing this syndemic.