Associations between alcohol use and HIV care cascade outcomes among adults undergoing population-based HIV testing in East Africa

Abstract

Objective: To assess the impact of alcohol use on HIV care cascade outcomes. Design: Cross-sectional analyses. Methods: We evaluated HIV care cascade outcomes and alcohol use in adults (≥15 years) during baseline (2013--2014) population-based HIV testing in 28 Kenyan and Ugandan communities. ‘Alcohol use’ included any current use and was stratified by Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scores: nonhazardous/low (1--3 men/1--2 women), hazardous/medium (4--5 men/3--5 women), hazardous/high (6--7), hazardous/very-high (8--12). We estimated cascade outcomes and relative risks associated with each drinking level using targeted maximum likelihood estimation, adjusting for confounding and missing measures. Results: Among 118 923 adults, 10 268 (9%) tested HIV-positive. Of those, 10 067 (98%) completed alcohol screening: 1626 (16%) reported drinking, representing 7% of women (467/6499) and 33% of men (1 159/3568). Drinking levels were: low (48%), medium (34%), high (11%), very high (7%). Drinkers were less likely to be previously HIV diagnosed (58% [95% CI: 55--61%]) than nondrinkers [66% (95% CI: 65–67%); RR: 0.87 (95% CI: 0.83–0.92)]. If previously diagnosed, drinkers were less likely to be on ART [77% (95% CI: 73–80%)] than nondrinkers [83% (95% CI 82–84%); RR: 0.93 (95% CI: 0.89–0.97)]. If on ART, there was no association between alcohol use and viral suppression; however, very-high-level users were less likely to be suppressed [RR: 0.80 (95% CI: 0.68–0.94)] versus nondrinkers. On a population level, viral suppression was 38% (95% CI: 36–41%) among drinkers and 44% (95% CI: 43–45%) among nondrinkers [RR: 0.87 (95% CI 0.82–0.94)], an association seen at all drinking levels. Conclusion: Alcohol use was associated with lower viral suppression; this may be because of decreased HIV diagnosis and ART use.

Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda

“…Our findings are consistent with Puryear et al (2020), who observed a significant association between VS and alcohol use when looking in their overall sample, but not when controlling for ART use (Puryear et al, 2020). Prior studies have found that ART use mediated the relationship between alcohol use and VS (Baum et al, 2010;Hahn and Samet, 2010).…”

“…regular binge drinking). The lack of precision regarding alcohol use behaviors captured by this variable may have reduced our ability to detect a significant association if the relationship between alcohol use and VS is strongest among those in the heaviest drinking categories, as has been observed in previous studies (Baum et al, 2010;Miguez et al, 2003;Puryear et al, 2020).…”

“…The relationship between VS and alcohol use may also be mediated by treatment adherence (Baum et al, 2010;Williams et al, 2016). A recent paper by Puryear et al examined associations between alcohol use and heavy drinking on VS (using a cut-off of <500 viral copies/mL) in a large sample from 28 East African study sites (Puryear et al, 2020). Among all PWH, regardless of ART use, they found a significant association between any alcohol use and VS.…”

Genomic epidemiology of Mycobacterium tuberculosis in Santa Catarina, Southern Brazil

“…Nonetheless, alcohol abuse or unhealthy alcohol usage is an increasingly acknowledged risk factor known to affect the outcome of TB treatment and a risk factor for TB treatment adherence 24 , 25 . Recent data obtained in Uganda and Kenya further demonstrate that alcohol use among HIV-infected individuals appears to be associated with decreased viral suppression due to the lower diagnosis rate and lower likelihood of being on an anti-retroviral treatment regimen if already HIV diagnosed 26 . In this regard, an integrated approach to reduce unhealthy alcohol consumption or illicit drug usage may lead to better outcomes 27 .…”

“…The spatial distribution of these cases and correlation with the genomic cluster shows an extensive geographical spread of the larger clusters (n ≥ 3) except for GC2, GC4 and GC10. The map was created using the online microreact tool, available at https ://micro react .org/proje ct/hrdK7 GcztX 8M2ZX EXjc5 79. www.nature.com/scientificreports/ to be associated with decreased viral suppression due to the lower diagnosis rate and lower likelihood of being on an anti-retroviral treatment regimen if already HIV diagnosed 26 . In this regard, an integrated approach to reduce unhealthy alcohol consumption or illicit drug usage may lead to better outcomes 27 .…”