Alcohol consumption increases non-adherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda.

Norbert Adrawa,John Bosco Alege,Jonathan Izudi,Tim Mathes

doi:10.1371/journal.pone.0242801

Abstract

Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV). Community-based ART delivery model offers a decentralized and patient-centered approach to care for PLHIV, with the advantage of improved adherence to ART hence good treatment outcomes. However, data are limited on the magnitude of non-adherence to ART among PLHIV enrolled to the community-based ART model of care. In this study, we determined the frequency of non-adherence to ART and the associated factors among PLHIV enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda. This analytic cross-sectional study randomly sampled participants from 21 community drug distribution points at the AIDS Support Organization (TASO) in Gulu district, northern Uganda. Data were collected using a standardized and pre-tested questionnaire, entered in Epi-Data and analyzed in Stata at univariate, bivariate, and multivariate analyses levels. Binary logistic regression analysis was used to determine factors independently associated with non-adherence to ART, reported using odds ratio (OR) and 95% confidence level (CI). The level of statistical significance was 5%. Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted (aOR), 3.24; 95% CI, 1.24-8.34). Other factors namely being single/or never married (aOR, 1.97; 95% CI, 0.62-6.25), monthly income exceeding 27 dollars (aOR, 1.36; 95% CI, 0.52-3.55), being on ART for more than 5 years (aOR, 0.60; 95% CI, 0.23-1.59), receipt of health education on ART side effects (aOR, 0.36; 95% CI, 0.12-1.05), and disclosure of HIV status (aOR, 0.37; 95% CI, 0.04-3.20) were not associated with non-adherence in this setting. Non-adherence to ART was low among PLHIV enrolled to community-based ART delivery model but increases with alcohol consumption. Accordingly, psychosocial support programs should focus on alcohol consumption.

Highlights

An estimated 37.9 million people are living with Human Immunodeficiency Virus (HIV) globally [1]
We determined the frequency of non-adherence to Anti-retroviral therapy (ART) and the associated factors among people living with HIV (PLHIV) enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda
Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted, 3.24; 95% confidence level (CI), 1.24–8.34)

Summary

Introduction

An estimated 37.9 million people are living with Human Immunodeficiency Virus (HIV) globally [1]. The goal of ART is to suppress the level of viral load among people living with HIV (PLHIV) to undetectable levels, to reduce the risk of morbidity and mortality, and to reduce transmission [4] To achieve these goals, good adherence to ART is critical because it ensures reduced risk of drug resistance, improved overall health, quality of life, and long term survival [4]. Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV).

Methods

Results

Conclusion