Prevalence and Correlates of Alcohol Dependence Disorder among TB and HIV Infected Patients in Zambia

Rebecca O’Connell,Nathaniel Chishinga,Vikram Patel,Soraya Seedat,Helen A Weiss,Helen Ayles,Eugene Kinyanda,Omar Sued

doi:10.1371/journal.pone.0074406

Abstract

ObjectivesTo determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia.Methods649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering.ResultsThe prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38).ConclusionsMale TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.

Highlights

Alcohol, HIV and TB are each major contributors to global disease burden and are closely inter-related [1]
In sub-Saharan Africa, evidence suggests that alcohol impacts on HIV risk with regards to number of partners, transactional sex, violence in relation to sex, condom use, intimate partner violence and drinking environment [2] [3] [4] [5] [6] [7]
It may be that risk-taking behaviors that influence alcohol use influence other sexual risk taking, or those with HIV infection turn to alcohol [5]

Summary

Introduction

HIV and TB are each major contributors to global disease burden and are closely inter-related [1]. Effective intervention strategies are needed within HIV and TB treatment centres that incorporate these inter-relationships at the individual, programmatic, and structural levels. Cross-sectional and qualitative studies suggest that alcohol relates to increased sexual risk taking behaviors [5,9]. It may be that risk-taking behaviors that influence alcohol use influence other sexual risk taking, or those with HIV infection turn to alcohol [5]. Studies do support a direct relationship between alcohol and HIV incident risk [3,10,11]. This includes a risk not just to the individual using alcohol, and to a female sexual partner [10]. In some settings, counseling interventions may be effective in reducing this risk [12]

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Results