High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda.

Greer A Raggio,Georgia Goodman,Jessica F Magidson,Lynn T Matthews,Gideon Amanyire,Judith A Hahn,Robin Fatch,Stephen Asiimwe,Christina Psaros,Jessica E Haberer,Anna Cross

doi:10.1097/qai.0000000000002156

Abstract

Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.

Highlights

Hazardous alcohol use is an ongoing problem among individuals living with HIV worldwide
The harms of alcohol use are even greater among pregnant women living with HIV (WLWH), in part because of the adverse health impact on the developing fetus
Alcohol use during pregnancy is associated with low birth weight, preterm delivery, and fetal alcohol syndrome, the latter of which affects as many as 21% of children in the Western Cape of South Africa.[7,8,9]

Summary

Introduction

Hazardous alcohol use is an ongoing problem among individuals living with HIV worldwide. In South Africa and Uganda, where HIV prevalence is among the highest in the world,[1] the prevalence of hazardous alcohol use (ranging from heavy drinking to alcohol use disorders) is 7%–31% among persons living with HIV.[2,3,4,5] Alcohol consumption among persons living with HIV is linked to lower adherence to antiretroviral therapy (ART) and, in some studies, compromised immunologic function and higher mortality.[6] The harms of alcohol use are even greater among pregnant women living with HIV (WLWH), in part because of the adverse health impact on the developing fetus. Alcohol use is common among people living with HIV and harmful during pregnancy. Objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions

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Results

Discussion

Conclusion