Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure

Abstract

Objective(s) People Living with HIV (PLHIV) on anti-retroviral treatment (ART) who drink are less adherent and more likely to engage in unprotected sex. Using an adapted Timeline Follow-Back (A-TLFB) procedure, this paper examines the day by day interface of alcohol, medication adherence and sex to provide a fine grained understanding of how multiple behavioral risks coincide in time and space, explores concordance/discordance of measures with survey data and identifies potential recall bias. Methods Data are drawn from a survey of behavior, knowledge and attitudes, and a 30 day TLFB assessment of multiple risk behaviors adapted for the Indian PLHIV context, administered to 940 alcohol-consuming, HIV positive men on ART at the baseline evaluation stage of a multilevel, multi-centric intervention study Results On days participants drank they were significantly more likely to be medication non-adherent and to have unprotected sex. In the first day after their alcohol consuming day, the pattern of nonadherence persisted. Binge and regular drinking days were associated with nonadherence but only binge drinking co-occurred with unprotected sex. Asking about specific “drinking days” improved recall for drinking days and number of drinks consumed. Recall declined for drinking days and nonadherence from the first week to subsequent weeks but varied randomly for sex risk. There was high concordance and low discordance between adapted TLFB drinking and nonadherence but these results were reversed for unprotected sex. Conclusions Moving beyond simple drinking-adherence correlational analysis, the adapted TLFB offers improved recall probes and provides researchers and interventionists with the opportunity to identify types of risky days and tailor behavioral modification to reduce alcohol consumption, nonadherence and risky sex on those days.

Human immunodeficiency virus infection and syphilis among homeless people in a large city of Central-Western Brazil: prevalence, risk factors, human immunodeficiency virus-1 genetic diversity, and drug resistance mutations

“…Investigations have reported the negative effects of alcohol consumption on HIV infection, which include risky sexual behavior (poor adaptation to or negotiation of condoms during sexual intercourse) and poor ART adherence. 30 Additionally, long-term alcohol use has been associated with more advanced HIV disease. 31 …”

Relationships between Antiretroviral Therapy Adherence with Personality Traits and Presence of Psychological Distress among Adults with Human Immunodeficiency Virus in Northwest Peninsular Malaysia: A Cross-Sectional Study

“…TLFB is based on day-to-day recall via the visual calendar to measure the quality of adherence in the recent past 14 days. Good adherence is defined as following the prescribed 14-day doses for 100% of the time (29). Apart from that, individuals with poor treatment adherence to ART therapy are also expected to have low viral load suppression as compared to individuals with good adherence (30).…”

Alcohol Use and the Risk of Communicable Diseases

“…More recently, HIV prevention efforts have emphasized biomedical approaches, which include HIV Pre-Exposure Prophylaxis (PrEP)-a medication taken daily by those living without HIV to prevent HIV acquisition [35,36]; and Treatment as Prevention (TasP)which involves people living with HIV taking antiretroviral therapy (ART) to achieve viral suppression, thereby eliminating the possibility of viral transmission [21][22][23]. Despite their biomedical basis, these approaches are directly reliant on a behavior, namely adherence, which has been shown to be negatively associated with alcohol use [18][19][20][37][38][39][40][41]. A variety of underlying mechanisms for this association have been proposed, which, for the sake of conciseness, are presented below under "Alcohol and HIV Disease Progression".…”

“…The successful treatment of HIV, which entails achieving viral suppression to halt disease progression, relies on enacting the behaviorally underpinned steps of the HIV care continuum that include HIV testing, linkage, and retention in HIV care, and ART initiation and adherence. Alcohol use has been associated with poor outcomes at all steps of the continuum [37,[64][65][66][67][68][69], and some evidence suggestive of the causal role of alcohol use, particularly with respect to adherence, has been yielded [17][18][19][20]. Alcohol-HIV care continuum associations can result from a range of mechanisms, including alcohol-related stigmatization that prevents alcohol users from accessing HIV testing and care [70,71], and alcohol-derived diminished cognitive functioning that poses a challenge for ongoing adherence and clinic attendance [72,73].…”

“…For example, the impact of alcohol on HIV/AIDS is mainly mediated by the impact of alcohol use on decision-making, resulting in riskier sexual behaviors [16] and lower adherence to virus suppression therapies [17][18][19][20], which results in higher transmission of HIV and other sexually transmitted diseases [21][22][23]. It took strong experimental methodology to ascertain that the widely recognized associations between alcohol and HIV/AIDS had substantial causal components (for more details, see [16,17]).…”