Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

B Myers,F Abdullah,D J Stein,P Petersen Williams,C Lombard,K R Sorsdahl,C Lund,J A Joska,T Naledi

doi:10.1007/s10461-021-03263-3

B Myers, F Abdullah + Show 7 more

Open Access

https://doi.org/10.1007/s10461-021-03263-3

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Abstract

This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.

Highlights

Despite the scale up of evidence-based HIV treatment, South African women continue to be disproportionately affected by HIV—comprising about 60% of the estimated 7.9 million South Africans living with HIV [1]
This paper aims to provide this information by examining (i) the associations between a range of alcohol consumption patterns and HIV viral suppression and (ii) the extent to which these associations are mediated by differences in adherence to antiretroviral therapy (ART) among a cohort of women obtaining treatment for HIV from primary care clinics in the Western Cape province of South Africa
This study presents some of the first information on specific patterns of alcohol use associated with viral non-suppression and the extent to which adherence to ART mediates these relationships for women living with HIV (WLWH)

Summary

Introduction

Despite the scale up of evidence-based HIV treatment, South African women continue to be disproportionately affected by HIV—comprising about 60% of the estimated 7.9 million South Africans living with HIV [1]. Access to antiretroviral therapy (ART) has dramatically reduced HIV morbidity and mortality [2, 3], only about 69% of South African adult women living with HIV (WLWH) are virally suppressed [1]. A substantial proportion (> 50%) of the adult population abstain from using alcohol, heavy episodic drinking (HED) is the normative pattern of alcohol use amongst people who drink [6, 7]. HED is sometimes referred to as binge drinking and is typically defined as the consumption of five

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