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Sevelius J, Veras MASM, Gomez JL, Saggese G, Mocello AR, Bassichetto KC, Neilands TB, Lippman SA. Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas. BMJ Open 2024; 14:e076878. [PMID: 38908840 DOI: 10.1136/bmjopen-2023-076878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER NCT03081559.
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Affiliation(s)
- Jae Sevelius
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jose Luis Gomez
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Gustavo Saggese
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Adrienne Rain Mocello
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Katia Cristina Bassichetto
- Department of Public Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA
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Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, Achoki T. Lay counsellors' experiences of administering the AUDIT-C as a brief screening tool in a South African township. BMC Health Serv Res 2023; 23:1227. [PMID: 37946216 PMCID: PMC10633970 DOI: 10.1186/s12913-023-10230-2] [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: 01/15/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention. METHODS This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences. RESULTS The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation. CONCLUSION Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved.
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Affiliation(s)
- Lynne Goldschmidt
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Buyisile Mncina
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Malose Langa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
- Centre for the Study of Violence and Reconciliation, CSVR, Johannesburg, South Africa
| | | | | | | | - Tom Achoki
- ABInBev Foundation, New York, USA
- Africa Institute for Health Policy, Nairobi, Kenya
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Lippman SA, Libby MK, Nakphong MK, Arons A, Balanoff M, Mocello AR, Arnold EA, Shade SB, Qurashi F, Downing A, Moore A, Dow WH, Lightfoot MA. A guaranteed income intervention to improve the health and financial well-being of low-income black emerging adults: study protocol for the Black Economic Equity Movement randomized controlled crossover trial. Front Public Health 2023; 11:1271194. [PMID: 38026401 PMCID: PMC10658785 DOI: 10.3389/fpubh.2023.1271194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Economic inequity systematically affects Black emerging adults (BEA), aged 18-24, and their healthy trajectory into adulthood. Guaranteed income (GI)-temporary, unconditional cash payments-is gaining traction as a policy solution to address the inequitable distribution of resources sewn by decades of structural racism and disinvestment. GI provides recipients with security, time, and support to enable their transition into adulthood and shows promise for improving mental and physical health outcomes. To date, few GI pilots have targeted emerging adults. The BEEM trial seeks to determine whether providing GI to BEA improves financial wellbeing, mental and physical health as a means to address health disparities. Methods/design Using a randomized controlled crossover trial design, 300 low-income BEA from San Francisco and Oakland, California, are randomized to receive a $500/month GI either during the first 12-months of follow-up (Phase I) or during the second 12-months of a total of 24-months follow-up (Phase II). All participants are offered enrollment in optional peer discussion groups and financial mentoring to bolster financial capability. Primary intention-to-treat analyzes will evaluate the impact of GI at 12 months among Phase I GI recipients compared to waitlist arm participants using Generalized Estimating Equations (GEE). Primary outcomes include: (a) financial well-being (investing in education/training); (b) mental health status (depressive symptoms); and (c) unmet need for mental health and sexual and reproductive health services. Secondary analyzes will examine effects of optional financial capability components using GEE with causal inference methods to adjust for differences across sub-strata. We will also explore the degree to which GI impacts dissipate after payments end. Study outcomes will be collected via surveys every 3 months throughout the study. A nested longitudinal qualitative cohort of 36 participants will further clarify how GI impacts these outcomes. We also discuss how anti-racism praxis guided the intervention design, evaluation design, and implementation. Discussion Findings will provide the first experimental evidence of whether targeted GI paired with complementary financial programming improves the financial well-being, mental health, and unmet health service needs of urban BEA. Results will contribute timely evidence for utilizing GI as a policy tool to reduce health disparities. Clinical trial registration https://clinicaltrials.gov, identifier NCT05609188.
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Affiliation(s)
- Sheri A. Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Michelle K. Nakphong
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Abigail Arons
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Emily A. Arnold
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | | | - William H. Dow
- Department of Health Policy and Management, University of California, Berkeley, Berkeley, CA, United States
| | - Marguerita A. Lightfoot
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR, United States
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Goldschmidt L, Mncina B, Langa M, Rebello S, Budaza T, Tshabalala J, Kinfu Y, Achoki T. AUDIT-C as a possible source of referral during the COVID-19 pandemic for participants presenting patterns of high-risk alcohol consumption in a South African township. BMC Public Health 2023; 23:1890. [PMID: 37775803 PMCID: PMC10542669 DOI: 10.1186/s12889-023-16775-5] [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: 11/15/2022] [Accepted: 09/16/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use is a leading contributor to premature death and disability worldwide. The World Health Organization's Global Status Report on Alcohol and Health ranked South Africa as having one of the riskiest patterns of alcohol consumption, which calls for intervention. Recognising the need for effective primary care interventions, particularly in the absence of appropriate alcohol-related harm reduction policies at national and local levels, this paper highlights the opportunities and challenges associated with a two-pronged, community-centred approach to the identification of unhealthy alcohol use and interventions. METHODS This approach included the use of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) as a means of screening to identify individuals at moderate (score of 5-7) to high risk (score of 8 +) alcohol use, raising awareness, and investigating the potential utility of brief advice and referrals as a means of reducing risk. RESULTS Of the 54,187 participants, 43.0% reported engaging in moderate-risk alcohol consumption, with 22.1% reporting high-risk alcohol consumption. Resistance to brief advice was observed to increase with higher AUDIT-C scores. Similarly, participants engaging in high-risk alcohol consumption were resistant to accepting treatment referrals, with fewer than 10% open to receiving a referral. CONCLUSIONS While men were most likely to report patterns of high-risk alcohol consumption, they were more resistant to accepting referrals. Additionally, participants who were willing to receive brief advice were often resistant to taking active steps to alter their alcohol use. This study highlights the need to consider how to prevent harmful patterns of alcohol use effectively and holistically, especially in low socioeconomic settings through primary health care and community services.
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Affiliation(s)
- Lynne Goldschmidt
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Buyisile Mncina
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Malose Langa
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
- Centre for the Study of Violence and Reconciliation, Johannesburg, South Africa
| | | | | | | | - Yohannes Kinfu
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
- United Nations University, International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Tom Achoki
- ABInBev Foundation, New York, NY, USA
- Africa Institute for Health Policy, Nairobi, Kenya
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Browne FA, Gichane MW, Shangase N, Ndirangu J, Bonner CP, Wechsberg WM. Social Determinants of Alcohol and Other Drug Misuse Among Women Living with HIV in Economically Underserved Communities in Cape Town, South Africa: A Cross-Sectional Study. AIDS Behav 2023; 27:1329-1338. [PMID: 36344731 PMCID: PMC9640812 DOI: 10.1007/s10461-022-03869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to understand how social determinants-the economic and social factors that affect health and well-being-are associated with self-reported and biological alcohol and other drug misuse in South Africa among women living with HIV. Logistic regression analyses were performed using baseline data from an implementation science trial conducted from 2015 to 2018 with 480 Black and Coloured women who were living with HIV and reported recent alcohol or other drug misuse. Educational attainment, type of housing, access to running water, food insecurity, and housing instability were examined. Women with higher education had reduced odds of any drug misuse-both biological (aOR: 0.53; 95% CI: 0.33-0.84) and self-reported (aOR: 0.37; 95% CI: 0.22-0.64). Women living in formal housing had increased odds of a positive alcohol screening test (aOR: 1.92; 95% CI: 1.16-3.18) and women with housing instability had increased odds of self-reported alcohol misuse-daily (aOR: 1.99; 95% CI: 1.18-3.35) and weekly (aOR:1.91; 95% CI: 1.19-3.07). Food insecurity was associated with reduced odds of self-reported alcohol misuse (aOR: 0.40; 95% CI: 0.25-0.64) and increased odds of self-reported drug misuse (aOR: 2.05; 95% CI: 1.16-3.61). These findings indicate the complexity of the relationship between social determinants and alcohol and other drug misuse, and may have implications for addressing social and structural determinants as part of multilevel interventions focused on reducing alcohol and other drug misuse among key populations of women in South Africa.
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Affiliation(s)
- Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
- Health Behavior, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Margaret W Gichane
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Nosipho Shangase
- Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Jacqueline Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC 27695, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA
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Drain PK, Dorward J, Violette LR, Quame-Amaglo J, Thomas KK, Samsunder N, Ngobese H, Mlisana K, Moodley P, Donnell D, Barnabas RV, Naidoo K, Abdool Karim SS, Celum C, Garrett N. Point-of-care HIV viral load testing combined with task shifting to improve treatment outcomes (STREAM): findings from an open-label, non-inferiority, randomised controlled trial. Lancet HIV 2020; 7:e229-e237. [PMID: 32105625 DOI: 10.1016/s2352-3018(19)30402-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/27/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monitoring HIV treatment with laboratory testing introduces delays for providing appropriate care in resource-limited settings. The aim of our study was to determine whether point-of-care HIV viral load testing with task shifting changed treatment and care outcomes for adults on antiretroviral therapy (ART) when compared with standard laboratory viral load testing. METHODS We did an open-label, non-inferiority, randomised controlled trial in a public clinic in Durban, South Africa. We enrolled HIV-positive adults (aged ≥18 years) who presented for their first routine HIV viral load test 6 months after ART initiation. Individuals were randomly assigned by a random number allocation sequence to receive either point-of-care viral load testing at enrolment and after 6 months with task shifting to enrolled nurses (intervention group), or laboratory viral load testing (standard-of-care group). The primary outcome was combined viral suppression (<200 copies per mL) and retention at 12 months after enrolment. A non-inferiority margin of 10% was used. Analysis was done by intention to treat. This study was registered with ClinicalTrials.gov, NCT03066128. FINDINGS Between Feb 24, 2017, and Aug 23, 2017, we screened 657 participants, and 390 were enrolled and randomly assigned to either the intervention group (n=195) or standard-of-care group (n=195). 175 (90%) individuals in the intervention group and 148 (76%) individuals in the standard-of-care group had the primary outcome of retention with viral suppression, a difference of 13·9% (95% CI 6·4-21·2; p<0·00040). 182 participants (93%) in the intervention group had viral suppression compared with 162 (83%) in the standard-of-care group (difference 10·3%, 3·9-16·8; p=0·0025); 180 (92%) and 162 (85%) were retained in care (7·7%, 1·3-14·2; p=0·026). There were no adverse events related to point-of-care HIV viral load testing or task shifting. INTERPRETATION Point-of-care viral load testing combined with task shifting significantly improved viral suppression and retention in HIV care. Point-of-care testing can simplify treatment and improve outcomes for HIV-positive adults receiving ART in resource-limited settings. FUNDING National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Paul K Drain
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Lauren R Violette
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Justice Quame-Amaglo
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA
| | - Katherine K Thomas
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Hope Ngobese
- Prince Cyril Zulu Communicable Disease Clinic, Durban Municipality, Durban, South Africa
| | - Koleka Mlisana
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa; National Health Laboratory Service, Durban, South Africa
| | - Pravikrishnen Moodley
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa; National Health Laboratory Service, Durban, South Africa; Department of Virology, Inkosi Albert Luthuli Central Hospital, Cato Manor, South Africa
| | - Deborah Donnell
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA
| | - Ruanne V Barnabas
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, and Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Epidemiology, Columbia University, New York, NY, USA
| | - Connie Celum
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Hahn JA, Emenyonu NI, Fatch R, Muyindike WR, Kekiibina A, Carrico AW, Woolf-King S, Shiboski S. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction 2016; 111:272-9. [PMID: 26381193 PMCID: PMC4715487 DOI: 10.1111/add.13173] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 07/20/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
AIMS We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone. DESIGN A prospective 1-year observational cohort study with quarterly visits. SETTING Large rural HIV clinic in Mbarara, Uganda. PARTICIPANTS A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption. MEASUREMENTS Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use. FINDINGS The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively. CONCLUSIONS Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
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Affiliation(s)
- Judith A Hahn
- University of California, Department of Medicine, San Francisco, CA, USA
- University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Nneka I Emenyonu
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Robin Fatch
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Winnie R Muyindike
- Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Allen Kekiibina
- Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Adam W Carrico
- University of California, Department of Community Health Systems, San Francisco, CA, USA
| | - Sarah Woolf-King
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Stephen Shiboski
- University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
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Asiimwe SB, Fatch R, Emenyonu NI, Muyindike WR, Kekibiina A, Santos GM, Greenfield TK, Hahn JA. Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa. Alcohol Clin Exp Res 2015; 39:1518-27. [PMID: 26148140 DOI: 10.1111/acer.12781] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Sub-Saharan Africa (SSA), HIV-infected patients may underreport alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type-adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel nonvolume measures, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). METHODS We analyzed cohort entry data from the Biomarker Research of Ethanol Among Those with HIV cohort study (2011 to 2013). Participants were HIV-infected past-year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman's rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CIs) for pairwise differences between coefficients. RESULTS A total of 209 subjects (57% men) were included. Median age was 30; interquartile range (IQR) 25 to 38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2,137) were higher than QF grams (375, IQR 33 to 1,776), p < 0.001. However, both measures were moderately correlated with PEth: ρ = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference -0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (ρ = 0.35 to 0.57). CONCLUSIONS HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed, suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other nonvolume measures may provide simpler alternatives.
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Affiliation(s)
- Stephen B Asiimwe
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, California
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, California
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.,Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Allen Kekibiina
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California.,Department of Community Health Systems, University of California, San Francisco, California
| | | | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
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Kaufman ZA, Braunschweig EN, Feeney J, Dringus S, Weiss H, Delany-Moretlwe S, Ross DA. Sexual risk behavior, alcohol use, and social media use among secondary school students in informal settlements in Cape Town and Port Elizabeth, South Africa. AIDS Behav 2014; 18:1661-74. [PMID: 24934651 DOI: 10.1007/s10461-014-0816-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
South Africa's HIV prevalence among young people remains among the highest in the world. A cross-sectional study was carried out in 2012 to estimate prevalences of sexual risk behavior and hazardous alcohol use (HAU) (via the Alcohol Use Disorder Identification Test) as well as to investigate potential associations between these outcomes and social media use. In all, 4485 students (mean age 15.66 years, SD 1.39) at 46 secondary schools in informal settlements in Cape Town and Port Elizabeth completed mobile-phone-assisted, self-administered baseline questionnaires within a cluster-randomized trial. In all, 312 females (12.5 %) and 468 males (23.5 %) screened positive for HAU (AOR = 1.98, 95 % CI 1.69-2.34). 730 males (39.9 %) and 268 females (11.8 %) reported having had two or more partners in the last year (AOR = 3.46, 95 % CI 2.87-4.16). Among females, having a Facebook account was associated with reported multiple partnerships in the last year (AOR = 1.81, 95 % CI 1.19-2.74), age-disparate sex in the last year (AOR = 1.96, 95 % CI 1.16-3.32) and HAU (AOR = 1.97, 95 % CI 1.41-2.74). Using Mxit-a popular mobile instant messaging application-was associated with higher odds of reported multiple partnerships in the last year among both males (AOR = 1.70, 95 % CI 1.35-2.14) and females (AOR = 1.45, 95 % CI 1.07-1.96) and with HAU among both males (AOR = 1.47, 95 % CI 1.14-1.90) and females (AOR = 1.50, 95 % CI 1.18-1.90). Further longitudinal and qualitative research should explore in more depth the observed links between social media and risk behavior.
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Affiliation(s)
- Z A Kaufman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK,
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Peltzer K, Ramlagan S, Khan MS, Gaede B. The social and clinical characteristics of patients on antiretroviral therapy who are 'lost to follow-up' in KwaZulu-Natal, South Africa: a prospective study. SAHARA J 2013; 8:179-86. [PMID: 23236959 DOI: 10.1080/17290376.2011.9725002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%) were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ART and 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20-3.49) and higher depression levels (RR=1.05, CI=1.01-1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59-163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome.
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Affiliation(s)
- Karl Peltzer
- Research Programme HIV/AIDS, STI and TB-HAST, Human Sciences Research Council, South Africa.
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