Understanding the Impact of Hazardous and Harmful Use of Alcohol and/or Other Drugs on ARV Adherence and Disease Progression.

Rajen Govender,Soraya Seedat,Rehana Kader,John Randy Koch,Graciela Andrei,Charles Parry

doi:10.1371/journal.pone.0125088

Rajen Govender, Soraya Seedat + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0125088

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Abstract

The objective of this study was to understand the impact of hazardous and harmful use of alcohol and/or other drugs on ARV adherence and disease progression among HIV patients. A cross-sectional study design was used. A total of 1503 patients attending HIV clinics in Cape Town, South Africa were screened for problematic substance use. A sub-sample of 607 patients (303 patients who screened positive for problematic substance use and 304 who did not) participated in this study. Hazardous or harmful alcohol use and problematic drug use predicted missing and stopping ARVs which, in turn, was associated with a decrease in CD4 counts and more rapid HIV-disease progression and poorer health outcomes in people living with HIV/AIDS (PLWHA). The findings of this study underscore the need for an integrated approach to managing substance-use disorders in PLWHA.

Highlights

The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have become a global pandemic and a major health challenge, especially in sub-Saharan Africa
To boost the sub-analyses of data, we included substance abusers and a comparison group of nonsubstance abusers at the eight clinics
The results indicate that harmful and hazardous use of alcohol and problematic drug use are statistically significant and important determinants of ARV adherence, and of health outcomes as measured by CD4 counts

Summary

Introduction

The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have become a global pandemic and a major health challenge, especially in sub-Saharan Africa. Like HIV, is another major health challenge facing these countries, South Africa. Alcohol continues to be the primary and most abused substance in South Africa, in recent years there has been an increase in the use of heroin, cocaine and amphetamine-type stimulants [1]. In the Western Cape for the reporting period July-December 2013, 86% of all admissions for substance abuse treatment were for methamphetamine (‘tik’), alcohol, cannabis and heroin. Methamphetamine was reported in 33% as a primary substance of abuse, cannabis was reported as common primary substance of abuse in 25% of admissions and Mandrax was reported in 21% and heroin in 13% of admissions in the Western Cape [2]

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