Trial experiences with dyadic breathalyzer technology for alcohol monitoring and feedback among couples living with HIV in South Africa

Dyadic monitoring tools could enhance partner awareness of drinking behaviors and prompt timely communication and supportive responses during alcohol use. We posited that real-time blood alcohol content (BAC) levels combined with motivational interviewing (MI) could facilitate couple communication, communal coping, and support, enabling couples to set joint goals and reduce alcohol consumption. We qualitatively explored the positive and negative experiences of trial participants who received mobile breathalyzer technology with couples MI to reduce unhealthy alcohol use in South Africa. Thirty couples (60 individuals) participated in a pilot trial combining couples-based MI with mobile breathalyzers. Index participants reporting unhealthy alcohol use and on antiretroviral therapy were assigned a portable breathalyzer linked to a smartphone app to complete twice-daily BAC tests. Partners received real-time SMS notifications of these BAC results. Both partners engaged in three MI sessions to reflect on drinking patterns and set alcohol reduction goals together. Transcripts from audio-recorded sessions and exit interviews from a subset of 12 individuals were analyzed using framework analysis. The data were coded for positive and negative experiences of using the breathalyzers and dyadic mechanisms of behavior change. Participants averaged 35.9 years old and had relationships averaging 6.6 years. Most couples (66.7%) had two partners reporting unhealthy drinking. Couples found the mobile breathalyzer technology engaging and enjoyable due to its novelty and social curiosity it sparked. Despite challenges related to connectivity issues, privacy, and technical difficulties, participants generally found workarounds and leveraged study resources like power banks and dedicated navigators. Participants described how the breathalyzers enhanced self-awareness of alcohol consumption, promoted home-based drinking, and fostered partner support and communication, though it sometimes led to tensions over technology allocation and usage, when only one partner received the device. Couples in a low-resource setting in South Africa successfully used breathalyzers to self-monitor alcohol consumption. Breathalyzers could be used to increase personal motivation to reduce alcohol use, activate partner support, and help partners coordinate efforts to achieve drinking goals. Addressing structural challenges like cellular connectivity, as well as dyadic equity by providing both partners with breathalyzers, will be critical to maximizing breathalyzer uptake and intervention impact in resource-poor settings. NCT05756790; registration date: 3/6/2023.