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It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub\u2010Saharan Africa (SSA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills\u2010based alcohol intervention among PWH with self\u2010reported unhealthy alcohol use (Alcohol Use Disorders Identification Test\u2013Consumption [AUDIT\u2010C], prior 3 months, \u22653\/female; \u22654\/male) and at risk of viral non\u2010suppression, defined as either recent HIV viral non\u2010suppression (\u2265400 copies\/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3\u2010month in\u2010person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (&lt;400 copies\/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT\u2010C or phosphatidylethanol (PEth), an alcohol biomarker, \u226550 ng\/ml at 24 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol\u2010serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93\u20131.1). Among PWH with baseline viral non\u2010suppression, 24\u2010week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93\u20131.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79\u20130.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56\u20130.88) than men (RR 0.93, 95% CI: 0.85\u20131.01) and among participants with a baseline PEth\u2a7d200 ng\/ml (RR 0.68, 95% CI: 0.53\u20130.87) versus &gt;200 ng\/ml (RR 0.97, 95% CI: 0.92\u20131.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non\u2010suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV\u2010associated co\u2010morbidities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26187","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T17:26:47Z","timestamp":1701883607000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0669-3293","authenticated-orcid":false,"given":"Sarah B.","family":"Puryear","sequence":"first","affiliation":[{"name":"Division of HIV, ID and Global Medicine University of California  San Francisco California 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