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The comparator arm (S&amp;R) received only brief alcohol screening feedback, referrals for alcohol counseling and HIV treatment counseling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>High\u2010risk alcohol use assessed via phosphatidylethanol (PEth) level at baseline and 6\u2009months and Alcohol Use Disorders Identification Test \u2010 Consumption (AUDIT\u2010C) (cutoff \u22659) at baseline, 3 and 6\u00a0months. Self\u2010reported ART adherence (\u226590% versus &lt;90%) assessed at baseline, 3 and 6\u00a0months. Secondary outcomes: number of days with \u22655 drinks in the prior 28\u2009days and HIV viral load. We assessed intervention fidelity by audio recording and transcribing sessions, then coding a random 20% sample for fidelity to protocol elements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Retention (92.5% completed all sessions) and fidelity (92.8\u2013100% across sessions) were high. Relative to the comparator arm, PEth values decreased from baseline to 6\u2010month follow\u2010up in the Kisoboka arm [difference in change \u2212126.87\u2009ng\/ml, 95% confidence interval (CI) = \u2212264.29 to 10.55], which was a small effect size (adjusted time* arm interaction: d\u2009=\u20090.14). The proportion with AUDIT\u2010C\u2009\u22659 decreased more in the Kisoboka arm between baseline and 6\u00a0months (\u221226.01%, 95% CI = \u221236.09% to \u221215.93%), a medium effect size time*arm effect (d\u2009=\u20090.68). Kisoboka did not improve adherence but protected against declines in optimal adherence observed in the S&amp;R arm (difference in change: 20.96%, 95% CI = 7.15% to 34.77%), which was a medium effect size time*arm effect (d\u2009=\u20090.51).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Kisoboka multilevel intervention to reduce high\u2010risk alcohol use appears to be feasible; it showed promising clinically meaningful small to medium size effects on reducing high\u2010risk alcohol use and protected against decreases in antiretroviral therapy adherence in a setting with strong contextual determinants of behavior.<\/jats:p>\n                  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