Background: “Tension” (referred as tenshun) is a term used across South Asia to talk about stress and distress. The term "Tenshun" is frequently used term to characterize common troubles and challenges like monetary concerns, relationship issues, and occupational stress. This longitudinal study examines the effects of multilevel interventions on "Tenshun" (tension) among men living with HIV (male PLWH) who consume alcohol in India.

Methods: This study utilized data from a randomized controlled clinical trial entitled ‘Alcohol and ART adherence: Assessment, Intervention, and Modeling in India’. Male PLWH were assessed for Tenshun from baseline through 27 months at 4 timepoints (baseline (T1), 9 months (T2), 18 months (T3) and 24 months (T4)). The interventions included individual counseling, group intervention, and collective advocacy for change, which were administered in each of three intervention sites. General linear mixed models were used to assess the change in Tenshun over time.

Results: A total of 940 men living with HIV were recruited and interviewed, of which 752 participants were assigned to the intervention group and 188 participants to the control group. The results showed that the intervention sequences had varying effects on Tenshun over time (T1 to T4) among the participants at different sites. At site 1, the GI-CA-IC intervention sequence resulted in significantly lower levels of Tenshun compared to the control group (β= -0.07; 95% CI= -0.09, -0.05; P<0.001). At Site 2, the IC-GI-CA intervention sequence was associated with lower levels of Tenshun compared to the control group, although the difference was not significant (β= -0.02; 95% CI= -0.04, 0.01; P=0.125). At Site 3, the CA-IC-GI intervention sequence resulted in significantly higher Tenshun compared to the control group (β= 0.05; 95% CI= 0.03, 0.08; P<0.001). At Site 4, the pilot comprehensive package intervention resulted in higher levels of Tenshun compared to the control group from T3 to T4 (β= 0.08; 95% CI= 0.06, 0.10; P<0.001).

Conclusions. The findings suggest the importance of multilevel interventions as well as intervention sequences for reducing “Tenshun” and provide valuable insights into the design and implementation of HIV prevention interventions for male PLWH in India and other similar setting.