Abstract
IntroductionExcessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub‐Saharan Africa.MethodsUsing a cross‐sectional approach, the Alcohol Use Disorders Identification Test (AUDIT‐C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT‐C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI).ResultsAmong 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking.ConclusionsAlcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV‐positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.
Highlights
Excessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care
We evaluated the proportion of the whole study population that reported binge drinking in each clinic, and repeated the multivariable analyses in the full study population
Our study showed a very high prevalence of excessive alcohol consumption among HIV-positive populations in four African countries, and highlights the diversity in drinking patterns across settings and subpopulations
Summary
Sub-Saharan Africa (SSA) has the highest prevalence of HIV globally, and accounts for 68% of people living with HIV (PLHIV) [1]. Excessive alcohol consumption leads to increased risk behaviour, notably condomless and coercive sex, which increase levels of HIV transmission [6,7,8] It has negative implications for the health of PLHIV: it has been associated with low rates of antiretroviral therapy (ART) initiation, poor engagement in medical care, virological failure and reduced survival [9,10,11]. A recent meta-analysis found a higher level of tobacco use among HIV-positive persons from low- and middle-income countries compared to negative ones [15]. Despite the recognized negative impact of excessive alcohol consumption on the health status of PLHIV, the prevalence and patterns of alcohol use among HIV-positive individuals attending clinical care in SSA have not been widely described. We compared the prevalence of binge drinking among the PLHIV participating in our study with estimates for the corresponding general population
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