Abstract
Almost 13 million people are estimated to be on antiretroviral therapy in Eastern and Southern Africa, and their disease course and program effectiveness could be significantly affected by the concurrent use of alcohol. Screening for alcohol use may be important to assess the prevalence of alcohol consumption and its impact on patient and programmatic outcomes. As part of this observational study, data on patient characteristics and alcohol consumption were collected on a cohort of 765 adult patients enrolling in HIV care in East Africa. Alcohol consumption was assessed with the AUDIT questionnaire at enrollment. Subjects were classified as consuming any alcohol (AUDIT score >0), hazardous drinkers (AUDIT score ≥8) and hyper drinkers (AUDIT score ≥16). The effects of alcohol consumption on retention in care, death and delays in antiretroviral therapy (ART) initiation were assessed through competing risk (Fine & Gray) models. Of all study participants, 41.6% consumed alcohol, 26.7% were classified as hazardous drinkers, and 16.0% as hyper drinkers. Depending on alcohol consumption classification, men were 3-4 times more likely to consume alcohol compared to women. Hazardous drinkers (median age 32.8 years) and hyper drinkers (32.7 years) were slightly older compared to non-hazardous drinkers (30.7 years) and non-hyper drinkers (30.8 years), (p-values = 0.014 and 0.053 respectively). Median CD4 at enrollment was 330 cells/μl and 16% were classified World Health Organization (WHO) stage 3 or 4. There was no association between alcohol consumption and CD4 count or WHO stage at enrollment. Alcohol consumption was associated with significantly lower probability of ART initiation (adjusted sub-distribution hazard ratio aSHR = 0.77 between alcohol consumers versus non-consumers; p-value = 0.008), and higher patient non-retention in care (aSHR = 1.77, p-value = 0.023). Alcohol consumption is associated with significant delays in ART initiation and reduced retention in care for patients enrolling in HIV care and treatment programs in East Africa. Consequently, interventions that target alcohol consumption may have a significant impact on the HIV care cascade.
Highlights
In 2017, there were 19.6 million [17.5 million– 22.0 million] people with HIV (PWH) in Eastern and Southern Africa [1]
Alcohol consumption is associated with significant delays in antiretroviral therapy (ART) initiation and reduced retention in care for patients enrolling in HIV care and treatment programs in East Africa
This prospective observational study was approved by the Indiana University Institutional Review Board and the ethical bodies affiliated with each participating site: The Academic Model Providing Access to Healthcare (AMPATH): Moi University College of Health Sciences and MOI Teaching and Referral Hospital’s Institutional Research and Ethics Committee; Family AIDS Care and Education Services (FACES): Kenya Medical Research Institute/National Ethics Review Committee; Mbarara Immune Suppression Syndrome (ISS) Clinic: Mbarara University of Science & Technology Institutional Review Committee
Summary
In 2017, there were 19.6 million [17.5 million– 22.0 million] people with HIV (PWH) in Eastern and Southern Africa [1]. As the number of patients accessing HIV care has rapidly increased in the past ten years, nearly 12.9 million people [11.4 million- 13.4 million] in Eastern and Southern Africa are on antiretroviral therapy (ART) [1]. Retention in care remains a significant challenge [2]. In East Africa only about 69% of patients initiating ART remain in care at the clinic of their initial enrollment after two years[3]. The investigation of factors that impact patterns of ART initiation and retention in care for patients enrolling in these programs is of particular significance
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