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Ayieko P, Kisanga E, Mshana G, Nkosi S, Hansen CH, Parry CDH, Weiss HA, Grosskurth H, Hayes RJ, Morojele NK, Kapiga S. Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management. AIDS Care 2024; 36:652-660. [PMID: 38295268 DOI: 10.1080/09540121.2023.2299324] [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] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%-15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10-7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92-9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence.
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Affiliation(s)
- Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Sebenzile Nkosi
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Neo K Morojele
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Medical Research, Mwanza, Tanzania
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Bell-Mandla N, Wilson E, Sharma D, Sloot R, Bwalya J, Schaap A, Donnell D, Piwowar-Manning E, Floyd S, Makola N, Nkonki L, Simwinga M, Moore A, Hayes R, Fidler S, Ayles H, Bock P. Predictors of participant retention in a community-based HIV prevention cohort: perspectives from the HPTN 071 (PopART) study. Trials 2023; 24:434. [PMID: 37370143 PMCID: PMC10294466 DOI: 10.1186/s13063-023-07404-y] [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] [Received: 07/27/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION In 2021, there were 38.4 million people living with HIV (PLHIV) globally, of which 20.6 million (54%) were living in Eastern and Southern Africa. Longitudinal studies, inclusive of community randomized trials (CRTs), provide critical evidence to guide a broad range of health care interventions including HIV prevention. In this study, we have used an individual-level cohort study design to evaluate the association between sex and other baseline characteristics and participant retention in the HPTN 071 (PopART) trial in Zambia and South Africa. METHODS HPTN 071 (PopART) was a community randomized trial (CRT) conducted from 2013 to 2018, in 21 communities. The primary outcome was measured in a randomly selected population cohort (PC), followed up over 3 to 4 years at annual rounds. PC retention was defined as completion of an annual follow-up questionnaire. Baseline characteristics were described by study arm and Poisson regression analyses used to measure the association between baseline factors and retention. In addition, we present a description of researcher-documented reasons for study withdrawal by PC participants. RESULTS Of the 38,474 participants enrolled during the first round of the trial (PC0), most were women (27,139, 71%) and 73% completed at least one follow-up visit. Retention was lower in men (adj RR: 0.90; 95% CI: 0.88, 0.91) and higher among older participants (adj RR: 1.23; 95% CI 1.20, 1.26) when comparing ages 35-44 to 18-24 years. Retention was higher among individuals with high socioeconomic status (SES) (adj RR 1.16; 95% CI 1.14, 1.19) and medium SES (adj RR 1.12; 95% CI 1.09, 1.14) compared to low SES. The most common reasons for study withdrawal were study refusal (23%) and relocation outside the CRT catchment area (66%). CONCLUSION Despite challenges, satisfactory retention outcomes were achieved in PopART with limited variability across study arms. In keeping with other studies, younger age, male sex, and lower SES were associated with lower levels of retention. Relocation outside of catchment area was the most common reason for non-retention in this CRT.
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Affiliation(s)
- Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Ethan Wilson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Deeksha Sharma
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Justin Bwalya
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
| | - Ab Schaap
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nozizwe Makola
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lungiswa Nkonki
- Department of Global Health, Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Musonda Simwinga
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
| | | | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Helen Ayles
- Zambia AIDS Related Tuberculosis Project, University of Zambia, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
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Giusto A, Romer A, Lovero K, dos Santos PF, Greene C, Gouveia L, Suleman A, Feliciano P, Oquendo MA, Mootz J, Wainberg ML. Examination of the Factor Structure of Psychopathology in a Mozambican Sample. Clin Psychol Sci 2023; 11:409-424. [PMID: 37181407 PMCID: PMC10181828 DOI: 10.1177/21677026221122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Factor-analytic studies are needed in global samples to advance understanding of psychopathology. We aimed to examine the structure of psychopathology and a general psychopathology ('p') factor using data from a cross-sectional study of 971 adults (63% women) from Maputo City, Mozambique. We used confirmatory factor analyses of symptoms from 15 psychiatric disorders to test common models of the structure of psychopathology. Models including internalizing, substance use, and thought disorder factors as well as a general p-factor fit the data well. Measurement invariance testing revealed that factor loadings on p differed by gender. Higher levels of p, internalizing, and thought disorder factors were associated with greater suicide risk, psychiatric comorbidity, chronic medical illnesses, and poorer functioning. A general psychopathology ('p') factor and internalizing, substance use, and thought disorder factors are identifiable in this Mozambican sample. Understanding psychopathology dimensions is a step toward building more scalable mental health service approaches globally.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Adrienne Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Belmont, MA, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Palmira Fortunado dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Antonio Suleman
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Paulino Feliciano
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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The Alcohol Use Disorders Identification Test and Mortality 20 Years later. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
The objective was to test whether Alcohol Use Disorders Identification Test (AUDIT) results may predict mortality after 20 years. An observational study was conducted. It included an interview of a general population sample aged 18 to 64 in northern Germany in the years 1996 − 1997 (baseline) and a mortality-follow-up in the years 2017 − 2018. Study participants were 3581 persons who had consumed alcohol during the last 12 months prior to the baseline assessment. It included the AUDIT which was filled in by study participants. At follow-up, death cases were ascertained including the date of death. Official records and death certificates from local health authorities were used. Cox proportional hazards regression revealed that the AUDIT predicted time to death. The hazard ratio was 1.70 (95% confidence interval: 1.43 − 2.02) with the lowest AUDIT zone of values as the reference group. Competing risks regression analysis for diagnosis-specific mortality data revealed that the AUDIT predicted cardiovascular mortality (subhazard ratio, 1.84; 95% confidence interval, 1.49 − 2.27). It is concluded that the alcohol screening predicted total and cardiovascular mortality in this adult general population sample.
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Hammett WH, Muanido A, Cumbe VFJ, Mukunta C, Manaca N, Hicks L, Dorsey S, Fabian KE, Wagenaar BH. Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique. AIDS Care 2023; 35:1-6. [PMID: 35348399 PMCID: PMC9519808 DOI: 10.1080/09540121.2022.2039356] [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] [Received: 01/07/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACTCommon mental disorders (CMDs) are associated with poor HIV outcomes in low- and middle-income countries. The present study implemented a psychological therapy delivered in routine HIV care and examined its effects on HIV outcomes in Mozambique. The Common Elements Treatment Approach (CETA) was integrated into routine HIV care in Sofala, Mozambique for all newly-diagnosed HIV+ patients with CMD symptoms. HIV treatment initiation and retention were compared to overall facility averages (those enrolled in CETA + those not enrolled). Of 250 patients screened, 59% (n = 148 met the criteria for CETA enrollment, and 92.6 (n = 137) enrolled in CETA. After four CETA visits, CMD symptoms decreased >50% and suicidal ideation decreased 100%. Patients enrolling in CETA had an antiretroviral therapy initiation rate of 97.1%, one-month retention of 69.2%, and three-month retention of 82.4%. Patients in the comparison group had one-month retention of 66.0% and three-month retention of 68.0%. CETA may be a promising approach to reduce symptoms of CMDs and improve HIV care cascade outcomes in areas with high HIV prevalence.
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Affiliation(s)
- Wilson H Hammett
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
| | | | - Vasco FJ Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | | | - Nelia Manaca
- Health Alliance International, Beira, Mozambique
| | | | - Shannon Dorsey
- University of Washington, Department of Psychology and Behavioral Sciences, Seattle, Washington
| | - Katrin E Fabian
- University of Washington, Department of Global Health, Seattle, Washington
| | - Bradley H. Wagenaar
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Fabian KE, Muanido A, Cumbe VFJ, Mukunta C, Manaca N, Dorsey S, Hammett WH, Wagenaar BH. Integrating a Transdiagnostic Psychological Intervention Into Routine HIV Care: A Mixed-Methods Evaluation of the Common Elements Treatment Approach in Mozambique. J Acquir Immune Defic Syndr 2022; 89:274-281. [PMID: 35147581 PMCID: PMC8851690 DOI: 10.1097/qai.0000000000002863] [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] [Received: 06/21/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We integrated a transdiagnostic psychological intervention (Common Elements Treatment Approach [CETA]) into routine HIV care in Sofala, Mozambique. This task-shared program screens and treats newly diagnosed HIV+ patients with comorbid mental health symptoms. METHODS A mixed-methods evaluation included demographics, intake screening scores, mental health symptoms, and barriers/facilitators to implementation examined through interviews. Multilevel models were used to analyze factors associated with symptom improvement and loss to follow-up (LTFU). RESULTS From March 2019 to June 2020, 820 individuals were screened for CETA treatment; 382 (46.6%) showed clinically significant mental health symptoms and attended 1484 CETA sessions. Of CETA patients, 71.5% (n = 273/382) had general mental distress, 7.3% (n = 28) had alcohol abuse/dependence, 12.0% (n = 46) had suicidal ideation, and 3.7% (n = 14) had other violent ideation; 66.2% (n = 253) had experienced at least 1 traumatic event at intake. Mental health symptoms decreased by 74.1% (17.0 to 4.4) after 5 CETA sessions, and 37.4% of patients (n = 143) achieved a ≥50% symptom reduction from intake. LTFU was 29.1% (n = 111), but 59.5% of LTFU patients (n = 66) achieved a ≥50% symptom reduction before LTFU. Facilitators for CETA implementation included readiness for change given the unaddressed burden of mental illness. Barriers included complexity of the intervention and stigma. CONCLUSIONS Approximately 45% of newly diagnosed HIV+ individuals in Mozambique have clinically significant mental health symptoms at diagnosis. Integrating CETA into routine HIV platforms has in-context feasibility. Future implementation studies can optimize strategies for patient retention and scale-up.
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Affiliation(s)
- Katrin E Fabian
- University of Washington, Department of Global Health, Seattle, Washington
| | | | - Vasco FJ Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | | | - Nelia Manaca
- Health Alliance International, Beira, Mozambique
| | - Shannon Dorsey
- University of Washington, Department of Psychology and Behavioral Sciences, Seattle, Washington
| | - Wilson H Hammett
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
| | - Bradley H Wagenaar
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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