Predicting harmful alcohol use prevalence in Sub-Saharan Africa between 2015 and 2019: Evidence from population-based HIV impact assessment.

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Harmful alcohol use is associated with significant risks to public health outcomes worldwide. Although data on harmful alcohol use have been collected by population-based HIV Impact Assessment (PHIA), there is a dearth of analysis on the effect of HIV/ART status on harmful alcohol use in the Sub-Saharan Africa (SSA) countries with PHIA surveys. A secondary analysis of the PHIA surveys: Namibia (n = 27,382), Tanzania (n = 1807), Zambia (n = 2268), Zimbabwe (n = 3418), Malawi (n = 2098), Namibia (n = 27,382), and Eswatini (n = 2762). Using R version 4.2, we analysed the uptake and correlates of harmful alcohol consumption in SSA. The cutoff point for statistically significant was P<0.05. Of the 12,460 persons, 15% used alcohol harmfully. Harmful alcohol use varied by countries and ranged from 8.7% in Malawi to 26.1% in Namibia (P<0.001). Being female or HIV-positive and on ART were associated with less-likelihood of harmful alcohol consumption however persons that were HIV-positive and not on ART was associated with higher likelihood of harmful alcohol use (OR = 1.49, 95% CI: 1.32-1.69, P<0.001). The best performing models were Lasso or Super Learner or Random Forest were the best performing models while gradient boosting models or sample mean did not perform well. Harmful alcohol use was high. Harmful alcohol use varied by countries, sex, age, HIV/ART status and marital status. Therefore, there is a need to introduce or enforce harmful alcohol use control policies in SSA through taking into account these characteristics.