Introduction
PWH, HIV viral suppression
Alcohol consumption is a critical driver of poor HIV outcomes,especially in sub-Saharan Africa (SSA), where both are extremely common (The vast majority of PWH live in low-income settings, thus low-cost alcohol interventions, such as brief counselling-based interventions, are needed. A meta-analysis of alcohol counselling interventions conducted among PWH worldwide, though primarily in high income countries, showed a small but significant effect on reducing total amount of alcohol consumed and on HIV viral suppression (It is also unknown how best to deliver low-cost alcohol interventions in low-income settings. Multi-session interventions that combine inperson visits with booster phone calls to reinforce the in-person counseling have shown efficacy (Lastly, the primary outcomes for all prior brief intervention trials were measured by self-report, which may be subject to social desirability bias because participants who are counselled to reduce alcohol use may be especially vulnerable to under-reporting (The primary aim was to conduct a three-arm randomized controlled trial (RCT) to examine the efficacy of a brief counselling-based intervention among PWH with unhealthy alcohol use in southwest Uganda. The intervention included two in-person sessions and booster sessions delivered by either monthly live counsellor phone calls or by twice-weekly automated two-way messaging. We compared each to a standard of care control at follow-up (six and nine months after baseline). Our primary outcomes were number of drinking days by self-report and PEth, and HIV viral suppression. We hypothesized that each format of the intervention would reduce alcohol use compared to the standard of care. We also examined intervention acceptability, uptake, and cost (described elsewhere).