Predictive Utility of Brief Alcohol Use Disorders Identification Test (AUDIT) for Human Immunodeficiency Virus Antiretroviral Medication Nonadherence

Abstract

Alcohol use negatively affects adherence to antiretroviral therapy (ART), thus HIV/AIDS providers need accurate, efficient assessments of alcohol use. Using existing data from an efficacy trial of two cognitive-behavioral ART adherence interventions, we sought to determine if results on two common alcohol screening tests (Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) and its binge-related question (AUDIT-3)) predict ART nonadherence. Twenty seven percent of the sample (n=308) were positive on the AUDIT-C and 34% were positive on the AUDIT-3. In multivariate analyses, AUDIT-C positive status predicted ART nonadherence after controlling for race, age, conscientiousness, and self-efficacy (p=.036). While AUDIT-3 positive status was associated with ART nonadherence in unadjusted analyses, this relationship was not maintained in the final multivariate model. The AUDIT-C shows potential as an indirect screening tool for both at-risk drinking and ART nonadherence, underscoring the relationship between alcohol and chronic disease management.

Alcohol and Associated Characteristics among Older Persons Living with Human Immunodeficiency Virus on Antiretroviral Therapy

“…In the present study, ART adherence was not associated with alcohol use or severity. However, multiple previous studies have identified associations between alcohol use and non-adherence to ART (5, 8, 10, 36). Because ART prescription and suboptimal adherence were study eligibility criteria, the present findings may not be generalizable to other samples of older PLWH, especially those with more variable adherence to ART.…”

“…Using a large variety of measures and definitions of unhealthy alcohol use, these studies have reported prevalences ranging from 8% on the low end (1) to approximately 42% on the high end (12, 14). Studies specifically using the AUDIT-C have identified prevalences ranging from 14% – 27% (8, 11, 13, 15, 33). The prevalence of unhealthy alcohol use identified using the AUDIT-C in the present study—22%—falls well within the range of previous estimates among PLWH and is similar to the general prevalence in the U.S. population (22.6%) (29).…”

“…Previous studies of PLWH have demonstrated that alcohol use is associated with delay to treatment (35), non-adherence to ART (5, 8, 10, 36), and faster HIV disease progression (3, 4, 6, 7, 16, 36, 37), as well as compromised general immune function (6), and increased comorbid medical disease (16, 38), including faster progression of liver disease related to hepatitis C (39). Moreover, unhealthy alcohol use may compromise the quality of HIV care received (11).…”

“…Specifically, among persons living with HIV (PLWH), studies have demonstrated that those who use alcohol have poorer adherence to antiretroviral therapy (ART) (7, 8), increased HIV disease progression (4-6), and poorer survival (9) than those who do not.…”

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…Finding from previous studies report contradictory outcomes, with the majority reporting a relationship between alcohol and adherence, with higher alcohol use being associated with lower adherence (Harris et al, 2011;Teixeira et al, 2013;Raboud et al, 2011;Broyles et al, 2011). In this study, it is possible that a relationship was not found between alcohol use and adherence because data were assessed at baseline and end of the intervention, it is possible that more changes could have been observed at 3, 6 months and 12 months post-intervention.…”