Addressing the intersection between alcohol consumption and antiretroviral treatment: needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa

Abstract

BackgroundAt the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined.This study aimed to ascertain the knowledge, attitudes and practices of primary healthcare workers concerning the concurrent consumption of alcohol of clinic attendees who are prescribed antiretroviral drugs. An assessment of the exchange of information on the subject between clinic attendees and primary healthcare providers forms an important aspect of the research. A further objective of this study is an assessment of the level of alcohol consumption of people living with HIV and AIDS attending public health facilities in the Western Cape Province in South Africa, to which end, the study reviewed health workers’ perceptions of the problem’s extent. A final objective is to contribute to the development of evidence-based guidelines for AIDS patients who consume alcohol when on ARVs. The overall study purpose is to optimise antiretroviral health outcomes for all people living with HIV and AIDS, but with specific reference to the clinic attendees studied in this research.MethodsOverall the research study utilised mixed methods. Three group-specific questionnaires were administered between September 2013 and May 2014. The resulting qualitative data presented here supplements the results of the quantitative data questionnaires for HIV and AIDS clinic attendees, which have been analysed and written up separately. This arm of the research study comprised two, separate, semi-structured sets of interviews: one face-to-face with healthcare workers at the same primary healthcare clinics from which the clinic attendees were sampled, and the other with administrators from the local government health service via email. The qualitative analysis from the primary healthcare worker interviews has been analysed using thematic content analysis.ResultsThe key capacity gaps for nurses include the definition of different patterns and volumes of alcohol consumption, resultant health outcomes and how to answer patient questions on alcohol consumption while on antiretroviral treatment. Not only did the counsellors lack knowledge regarding alcohol abuse and its treatment, but they were also they were unclear on their role and rights in relation to their patients. Doctors highlighted the need for additional training for clinicians in diagnosing alcohol use disorders and information on the pharmacological interventions to treat alcoholism.ConclusionPertinent knowledge regarding patient alcohol consumption while taking ARVs needs to be disseminated to ...

Alcohol and substance use prevention in Africa: systematic scoping review

“…The results indicate alcohol (Birhanu et al, 2014 Ghebremichael et al, 2009;Glozah et al, 2015;Kalema et al, 2015;Koopman et al, 2008;Medley et al, 2014;Onya et al, 2012;Papas et al, 2012;Peltzer & Pengpid, 2012;Schneider et al, 2016;Takahashi et al, 2018Takahashi et al, , 2017Watt et al, 2016;Wechsberg et al, 2008) as the most predominantly used substance in most of the countries. The second commonly reported type of substance used in other countries is cigarette smoking (Ali et al, 2012;Birhanu et al, 2014;Embleton et al, 2013;Gravely et al, 2018;Jradi et al, 2013;Peltzer & Pengpid, 2012;Sreeramareddy et al, 2014;Takahashi et al, 2017).…”

“…Diverse presentations were also observed with regard to study settings. For instance, out of the 12 studies in the Southern region, 10 were from South Africa (Cubbins et al, 2012;Koopman et al, 2008;Meade et al, 2015;Medley et al, 2014;Mushanyu et al, 2017;Onya et al, 2012;Peltzer & Pengpid, 2012;Scheibe et al, 2016;Schneider et al, 2016;Watt et al, 2016;Wechsberg et al, 2008), and the study settings were urban (Koopman et al, 2008;Peltzer & Pengpid, 2012;Scheibe et al, 2016;Wechsberg et al, 2008), rural (Cubbins et al, 2012), and peri-urban areas (Meade et al, 2015;Onya et al, 2012;Watt et al, 2016).…”

Transtorno Por Uso De Álcool E Hiv/Aids: Uma Revisão Da Literatura

“…154 . Outra informação importante é a de que o TUA acelera a progressão da AIDS, mesmo que os ARVs sejam utilizados de forma correta, afetando negativamente a absorção e o metabolismo destes medicamentos 13,155 . Em adição a isso, este transtorno aumenta o risco de DSTs e de transmissão do HIV, e nesse cenário as chamadas "superinfecções ou coinfecções" podem ocorrer aumentando a probabilidade de resistência aos tratamentos medicamentosos 156 .…”

Advancing a cascading train-the-trainer model of frontline HIV service providers in South Africa: protocol of an implementation trial

“…While South Africa has exceptional HIV treatment expertise, there is a severe human resource shortage for specialist alcohol and other substance use disorder treatment [16]. With only 0.32 psychologists, 0.28 psychiatrists, and 0.4 social workers for every 100,000 individuals, the current workforce lacks the knowledge and skill needed to address the intertwined public health crises of alcohol and HIV [17]. A qualitative study of primary healthcare workers, nurses, and lay workers in South Africa found that health professionals treating HIV lacked basic knowledge about: the criteria for harmful alcohol use; screening tools to assess risky alcohol use; and effective interventions to treat alcohol problems [17].…”

“…With only 0.32 psychologists, 0.28 psychiatrists, and 0.4 social workers for every 100,000 individuals, the current workforce lacks the knowledge and skill needed to address the intertwined public health crises of alcohol and HIV [17]. A qualitative study of primary healthcare workers, nurses, and lay workers in South Africa found that health professionals treating HIV lacked basic knowledge about: the criteria for harmful alcohol use; screening tools to assess risky alcohol use; and effective interventions to treat alcohol problems [17]. In recent years, the South African National Department of Health and several national organizations have called for increased training of frontline treatment providers in screening and brief alcohol intervention as a means of mitigating the effects of alcohol on the HIV care continuum [18].…”