Expanding a program in Kenya that fights the spread of HIV by curbing alcohol consumption could produce a net economic benefit, a new study projects.

Public health research shows that alcohol may be a factor in more than 13 percent of deaths due to infectious diseases, including HIV. Drinking undermines the fight against the virus in two main ways, researchers have found: it makes transmission through risky sex more likely and undermines health by relaxing the rigor with which infected people take virus–suppressing medicine.

Over the last few years, Rebecca Papas – research assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University – has worked with experts in Kenya to bottle up the advance of the country’s HIV epidemic (and related violence) by piloting a culturally adapted cognitive behavioral therapy (CBT) program to promote alcohol abstinence among HIV–infected residents.

Now, building on the pilot program’s results, a new study led by economist Omar Galárraga, an assistant professor at the Brown University School of Public Health, projects that scaling the program up nationwide would save money by preventing costly new infections and improving productivity among the population.

The key, according to Galárraga, Papas and co–authors of the study published in BMC Health Services Research, is that treatment can be successfully delivered by “paraprofessionals” with limited training, who are in far greater abundance than the nation’s limited number of psychiatrists, estimated to be 75 in 2010. Those with as little as a high school education have been successful trainees in the pilot program.

“In our pilot intervention study, we demonstrated that trained paraprofessional therapists in Kenya were independently rated to be as competent as college–educated U.S. therapists when delivering a standardized CBT intervention to reduce alcohol use,” Papas said. “This new cost–effectiveness study goes a step further by considering the long–term health and economic benefits to rolling out this task–shifting approach to more people.”

The cost to treat 13,440 people over five years would be $554,000, but the benefits of reduced HIV drug costs and improved worker productivity would be valued at $628,000, according to the team’s “base case” projections.

In trials of the pilot program involving about 700 HIV–infected Kenyans who receive antiretroviral medications and also drink alcohol, the team showed that trained paraprofessionals can boost alcohol abstinence rates to 69 percent compared with just 38 percent using the prior standard of care. CBT, which can be delivered to groups in weekly sessions with monthly refreshers, helps participants explore their thoughts, actions and feelings in situations where the risk of drinking is acute, so that they can better resist it.