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Brown JL, Capasso A, Revzina N, Boeva E, Rassokhin V, Sales JM, Gutova LV, Khalezova NB, Hitch AE, Twitty TD, DiClemente RJ. Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection. AIDS Behav 2023; 27:4062-4069. [PMID: 37378797 DOI: 10.1007/s10461-023-04120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.
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Affiliation(s)
- Jennifer L Brown
- Department of Psychological Sciences, Purdue University, 703 3rd Street, Room 1242, West Lafayette, IN, 47907, USA.
| | | | - Natalia Revzina
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ekaterina Boeva
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
- Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Vadim Rassokhin
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
- Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Jessica M Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lyudmila V Gutova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Nadia B Khalezova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Anthony E Hitch
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - T Dylanne Twitty
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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Brown JL, Gause NK, Braun R, Punches B, Spatholt D, Twitty TD, Sprunger JG, Lyons MS. Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation. Health Promot Pract 2023:15248399231193005. [PMID: 37650616 DOI: 10.1177/15248399231193005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. METHODS Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse-Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). RESULTS Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. CONCLUSIONS Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.
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Affiliation(s)
| | - Nicole K Gause
- Duquesne University Counseling Services, Pittsburgh, PA, USA
| | - Robert Braun
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brittany Punches
- The Ohio State University, Columbus, OH, USA
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - David Spatholt
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | - Joel G Sprunger
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael S Lyons
- The Ohio State University Wexner Medical Center, Columbus, OH USA
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Khalezova N, Capasso A, Boeva E, Gutova L, Rassokhin V, Neznanov N, Belyakov N, Brown J, DiClemente R. Situational and motivational factors associated with unhealthy alcohol use among Russian women with HIV and hepatitis C Virus co-infection. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35783993 PMCID: PMC9246056 DOI: 10.1016/j.dadr.2022.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis. AIDS Behav 2021; 25:3734-3742. [PMID: 34014428 DOI: 10.1007/s10461-021-03270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Alcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18-35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = - 81, - 2; z = - 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.
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Brown JL, Anastasakis I, Revzina N, Capasso A, Boeva E, Rassokhin V, Crusey A, Sales JM, Hitch A, Renfro T, DiClemente RJ. Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV. J Int Assoc Provid AIDS Care 2021; 20:23259582211044920. [PMID: 34668412 PMCID: PMC8532257 DOI: 10.1177/23259582211044920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection. Methods: The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed. Results: We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components. Discussion: Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.
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Affiliation(s)
- Jennifer L Brown
- 2514University of Cincinnati, Cincinnati, Ohio, USA.,12303University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,12303Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Natalia Revzina
- Office for Clinical Research, 1371Emory University, Atlanta, Georgia, USA
| | - Ariadna Capasso
- School of Global Public Health, 5894New York University, New York, New York, USA
| | - Ekaterina Boeva
- 104721First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia.,Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Vadim Rassokhin
- 104721First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia.,Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Adrienne Crusey
- 12303University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,12303Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica M Sales
- Rollins School of Public Health, 25798Emory University, Atlanta, Georgia, USA
| | | | - Tiffaney Renfro
- Rollins School of Public Health, 25798Emory University, Atlanta, Georgia, USA
| | - Ralph J DiClemente
- School of Global Public Health, 5894New York University, New York, New York, USA
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DiClemente RJ, Brown JL, Capasso A, Revzina N, Sales JM, Boeva E, Gutova LV, Khalezova NB, Belyakov N, Rassokhin V. Computer-based alcohol reduction intervention for alcohol-using HIV/HCV co-infected Russian women in clinical care: study protocol for a randomized controlled trial. Trials 2021; 22:147. [PMID: 33596972 PMCID: PMC7887790 DOI: 10.1186/s13063-021-05079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Russia has a high prevalence of human immunodeficiency virus (HIV) infections. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with hepatitis C virus (HCV), and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. Despite the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care. Methods In this two-arm parallel randomized controlled trial, we propose to evaluate the efficacy of a culturally adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21–45 years old with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG), and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence and concealment of allocation techniques to minimize assignment bias. Women are randomized to either (1) the computer-based alcohol reduction intervention or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard of care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load and CD4+ levels) and HCV markers of disease progression (FibroScan). Discussion The proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants. The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated into clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis. Trial registration ClinicalTrials.gov NCT03362476. Registered on 5 December 2017
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Affiliation(s)
| | - Jennifer L Brown
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA.,Addiction Sciences Division, Department of Psychiatry & Behavioural Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Center for Addiction Research, University of Cincinnati, Cincinnati, OH, USA
| | - Ariadna Capasso
- School of Global Public Health, New York University, New York, NY, USA
| | - Natalia Revzina
- Clinical Trials Compliance, Office for Clinical Research, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jessica M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ekaterina Boeva
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia.,Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Lyudmila V Gutova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Nadia B Khalezova
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia
| | - Nikolay Belyakov
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia.,Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
| | - Vadim Rassokhin
- First Saint Petersburg State Pavlov Medical University, Saint Petersburg, Russia.,Saint Petersburg Pasteur Institute, Saint Petersburg, Russia
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Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol Use. AIDS Behav 2017; 21:1938-1949. [PMID: 28421353 DOI: 10.1007/s10461-017-1769-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman's r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.
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