Factors associated with hazardous alcohol use and motivation to reduce drinking among HIV primary care patients: Baseline findings from the Health &amp; Motivation study

Silverberg, Michael J.; Leyden, Wendy A.; Leibowitz, Amy; Hare, C. Bradley; Jang, Hannah; Sterling, Stacy; Catz, Sheryl L.; Parthasarathy, Sujaya; Horberg, Michael A.; Satre, Derek D.

doi:10.1016/j.addbeh.2018.03.033

Cited by 19 publications

(9 citation statements)

References 47 publications

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“…52 Taken together, the results and extant literature imply a need to address the manifestations of these negative health and psychological effects of stigma, in addition to stigmareduction efforts. In particular, programs to increase social support may produce positive change in treatment selfefficacy, 36 and interventions to treat clinical as well as subclinical anxiety and depressive symptoms have the potential to reduce coping by substance use 53 and improve ART adherence. 54 Limitations of this study include the cross-sectional study design, which precludes conclusions about causality.…”

Section: Discussionmentioning

confidence: 99%

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Rice

Turan

Fletcher

et al. 2019

AIDS Patient Care and STDs

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Among places where people living with HIV experience and anticipate HIV-related stigma, stigma in health care settings may be particularly harmful. Utilizing an exploratory sequential mixed methods approach, we conducted interviews (n = 76) and questionnaires (N = 460) with older adult women living with HIV enrolled in the Women's Interagency HIV Study in Birmingham, AL; Jackson, MS; Atlanta, GA; and San Francisco, CA. Interviews addressed facilitators and barriers to HIV treatment adherence, including HIV-related stigma. Qualitative data were coded using thematic analysis. Questionnaires assessed self-reported antiretroviral therapy (ART) adherence and experienced and anticipated HIV-related stigma from various sources (i.e., health care personnel, family, partner, and community). Covariate-adjusted logistic regression analyses examined total and mediated effects of stigma on ART adherence. Interviewees described fears and experiences of stigma in health care settings; including privacy violations, disrespect for patient autonomy, and reproductive coercion; and how these influenced their adherence to HIV treatment recommendations. Experienced and anticipated HIV-related stigma in health care settings were associated with suboptimal (or <95%) ART adherence in separate models controlling for experienced or anticipated stigma, respectively, from other sources. When entered together, only anticipated stigma in health care settings was associated with suboptimal ART adherence, controlling for anticipated and experienced stigma from other sources. The effect of anticipated stigma in health care settings on suboptimal ART adherence may work through the pathways of lower adherence self-efficacy, higher depressive symptoms, and higher coping by substance use. These findings indicate that interventions should promote cultures of acceptance within health care settings and resilience-based strategies for women to combat stigma and promote life-sustaining behaviors.

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Section: Discussionmentioning

confidence: 99%

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

Rice

Turan

Fletcher

et al. 2019

AIDS Patient Care and STDs

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“…of male with AUDNo. of female with AUDPrevalence of AUD (%)Silverberg et al, 2013 [25]USRCT2013–1561449.4AUDITNANA48Segni et al, 2017 [7]EthiopiaCross-sectional2016418NAAUDIT1011424.7Silva et al, 2017 [26]BrazilCross-sectional2012–334342.2 (11.1)AUDIT712728.6Crane et al, 2017 [27]USLongitudinal study2013–20158567NAAUDIT198328727Nouaman et al, 2018 [28]Four African countriesCross-sectional2013–4182439AUDIT25613638.4Pokhrela et al, 2018 [29]NepalCross-sectional201568236.3 (8.2)AUDIT1245125.7Egbe et al, 2017 [30]NigeriaCross-sectional2015118739.3 (9.1)CIDI17914Rosmary, 2015 [31]KenyaCross-sectional2015178NAAUDIT27933Kibera et al, 2017 [32]KenyaCross-sectional2014272NAAUDIT33514Goar et al, 2011 [13]NigeriaCross-sectionalNA16035.6 (8.66)AUDIT352839.4Mayston et al, 2015 [33]IndiaCross-sectional2010193435AUDITNANA12.8Zelalem et al, 2018 [34]EthiopiaCross-...…”

Section: Methodsmentioning

confidence: 99%

The prevalence of alcohol use disorders among people living with HIV/AIDS: a systematic review and meta-analysis

Duko

Ayalew

Ayano³

2019

Subst Abuse Treat Prev Policy

127

107

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BackgroundAlcohol use disorder (AUD) is common among people living with HIV/AIDS (PLWHA) and associated with a greater risk of poor medication adherence, unsafe sexual behaviors as well as poor quality of life. To our knowledge, there is no previous systematic review and meta-analysis that reported the pooled prevalence estimate of AUD among PLWHA. Therefore, this review aimed to systematically review the available studies on the prevalence of AUD among PLWHA and forward possible recommendations for future clinical practice and research.MethodsPubMed, EMBASE, Psych INFO and SCOPUS databases were searched to identify the relevant studies. We have also scanned the reference lists of the eligible studies to supplement our electronic search. We used the Comprehensive Meta-Analysis software versions 3.0 to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran’s Q- and the I2- test were employed to see the heterogeneity. The presence of publication bias was explored by utilizing Egger’s test and visual inspection of the symmetry in funnel plots.ResultsA total of 25 studies with 25,154 participants across developed and developing countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence estimate of AUD among PLWHA was found to be 29.80% (95% CI; 24.10–35.76). The prevalence of AUD was higher in males (26.90%) than female (13.37%) HIV patients. In this study, the pooled prevalence of AUD was considerably higher (31.52%) when measured by Alcohol Use Disorders Identification Test (AUDIT) as compared to Composite International Diagnostic Interview (CIDI) (13.51%). In addition, the pooled prevalence of AUD was higher in the developed countries (42.09%) while lower for developing countries (24.52%).ConclusionIn the current study, the pooled prevalence estimates of AUD among PLWHA was considerably high (29.80%). Screening and appropriate management of AUD among PLWHA are recommended.

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“…Hazardous drinking is defined as the quantity and pattern of alcohol consumption that increases adverse health outcomes, while alcohol dependence – a higher level of alcohol use disorder – is defined as a strong desire to consume alcohol, difficulties in controlling its use, and persistent use despite harmful consequences [25,26]. An estimated 25% to 50% of PWH are hazardous drinkers [27‐29], and about 10.6% of PWH had both depression symptoms and harmful levels of alcohol use [30]. PWH with hazardous alcohol use are even more vulnerable to mental disorders than PWH without drinking issues [31], and they may have unique challenges that make abstinence difficult.…”

Section: Introductionmentioning

confidence: 99%

The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam

et al. 2021

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Introduction Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association. Methods This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test‐Concise (AUDIT‐C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time‐lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation. Results The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. Conclusions Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.

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Factors associated with hazardous alcohol use and motivation to reduce drinking among HIV primary care patients: Baseline findings from the Health & Motivation study

Abstract: This study identified modifiable participant characteristics associated with alcohol outcomes in PWH, including anxiety and depression severity, tobacco use, and other substance use.

Cited by 19 publications

References 47 publications

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

A Mixed Methods Study of Anticipated and Experienced Stigma in Health Care Settings Among Women Living with HIV in the United States

The prevalence of alcohol use disorders among people living with HIV/AIDS: a systematic review and meta-analysis

The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam

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