Abstract
BackgroundAlcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. HIV counseling and testing (HCT) may provide a contact opportunity to intervene with hazardous alcohol use; however, little is known about how alcohol consumption changes following HCT.MethodsWe utilized data from 2056 participants of a randomized controlled trial comparing two methods of HCT and subsequent linkage to HIV care conducted at Mulago Hospital in Kampala, Uganda. Those who had not previously tested positive for HIV and whose last HIV test was at least one year in the past were eligible. Participants were asked at baseline when they last consumed alcohol, and prior three month alcohol consumption was measured using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) at baseline and quarterly for one year. Hazardous alcohol consumption was defined as scoring ≥3 or ≥4 for women and men, respectively. We examined correlates of alcohol use at baseline, and of hazardous and non-hazardous drinking during the year of follow-up using multinomial logistic regression, clustered at the participant level to account for repeated measurements.ResultsPrior to HCT, 30% were current drinkers (prior three months), 27% were past drinkers (>3 months ago), and 44% were lifetime abstainers. One-third (35%) of the current drinkers met criteria for hazardous drinking. Hazardous and non-hazardous self-reported alcohol consumption declined after HCT, with 16% of baseline current drinkers reporting hazardous alcohol use 3 months after HCT. Independent predictors (p < 0.05) of continuing non-hazardous and hazardous alcohol consumption after HCT were sex (male), alcohol consumption prior to HCT (hazardous), and HIV status (negative). Among those with HIV, non-hazardous drinking was less likely among those taking antiretroviral therapy (ART).ConclusionsHCT may be an opportune time to intervene with alcohol consumption. Those with HIV experienced greater declines in alcohol consumption after HCT, and non-hazardous drinking decreased for those with HIV initiating ART. HCT and ART initiation may be ideal times to intervene with alcohol consumption. Screening and brief intervention (SBI) to reduce alcohol consumption should be considered for HCT and HIV treatment venues.
Highlights
Alcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa
Participant characteristics 3389 participants were enrolled in the main study; HIV prevalence was 30% (n = 1003). 1323 HIV negatives were randomized to no follow-up, and 10 participants were missing data on baseline alcohol use; 2056 participants were included in the baseline analysis
If alcohol consumption declined for the reasons noted above, these findings suggest that hospital and clinic entry, HIV counseling and testing (HCT), and for those infected with HIV, antiretroviral therapy (ART) initiation, may be opportune times to intervene on alcohol use, and future interventions should capitalize on these opportunities
Summary
Alcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. Heavy alcohol consumption is known to have detrimental effects on health, accounting for approximately 4.5% of the global burden of disease and injury world-wide [1]. Heavy alcohol use is a common and growing problem in sub-Saharan Africa (SSA). In Uganda, heavy alcohol consumption among drinkers is especially common [1]. Sub-Saharan Africa is home to nearly 70% of the global HIV infections (UNAIDS report 2011), and the heavy alcohol consumption in this region exacerbates the problem for multiple reasons [2]. Alcohol consumption and drinking venue attendance in SSA have been associated with increased HIV risk behaviors, such as number of sexual partners, unprotected sex, and commercial sex work [3,4], as well as prevalent [5,6] and incident HIV infection [7,8,9]. Alcohol consumption is consistently associated with decreased antiretroviral therapy (ART) adherence in western countries [15], and increasingly in SSA [16,17,18,19,20,21,22,23], and heavy alcohol consumption has been associated with decreased retention in care [24]
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