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Semá Baltazar C, Muleia R, Ribeiro Banze A, Boothe M. Prevalence and correlates of hazardous alcohol drinking and drug use among female sex workers and men who have sex with men in Mozambique. BMC Public Health 2024; 24:872. [PMID: 38515116 PMCID: PMC10956320 DOI: 10.1186/s12889-024-18273-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Hazardous drinking and drug consumption are associated with an increased risk of HIV due to the complex interplay of factors influencing decision-making capability, stigma and social marginalization. In this study, we explore the patterns of hazardous alcohol and drug use and correlates of risk factors among female sex workers (FSW) and men who as sex with men (MSM) in Mozambique. METHODS We conducted a secondary data analysis of bio-behavioral surveys (BBS) among FSW and MSM using a respondent-driven sampling methodology conducted in five main urban areas of Mozambique from 2019 to 20. The survey included a standardized questionnaire, where hazardous drinking was assessed (using AUDIT-C scores ≥ 4 for men, ≥ 3 for women) and drug use in the last year (FSW). Chi-squared test was used to analyze the association between socio-demographic and behavioral variables, and multivariate logistic regression measured the impact of the associated factors. RESULTS The prevalence of hazardous alcohol drinking was 47.1% (95% CI:44.8-49.5) for FSW and 46.5 (95% CI: 44.0-49.0) for MSM. Current drug use was reported in 13.3% of FSW. FSW engaging in hazardous alcohol drinking reported more sexual partners in the last month than those no reporting hazardous alcohol use (55.3% vs. 47,1%, p < 0.001), higher rates of self-reported STIs in the last year (62,5% vs. 48,2%, p < 0.001), physical (53.5% vs. 46.7%, p < 0.0001) and sexual violence (54.7% vs. 44.2%, p < 0.001), and HIV prevalence (55.2% vs. 44.2 p < 0.001). Among MSM with hazardous alcohol drinking, there was a higher prevalence of self-reported STIs (52.8% vs. 45.4%, p < 0.001), experiences of sexual violence (18.0% vs. 8.3%, p < 0.001), and HIV prevalence (53.0% vs. 46.3%, p < 0.001). In addition, FSW who reported illicit drug use were more likely to self-reported HIV own risk (14.2% vs. 9.7%), early start sexual activity (15.4% vs. 5.3%), self-reported STIs (17.9% vs. 10.2%), and experiences of both physical (17.4% vs. 7.0%) and sexual violence (18.6% vs. 8.9%). CONCLUSION There is an immediate need for the introduction and integration of comprehensive substance use harm mitigation and mental health interventions into HIV prevention programs, particularly those targeting key populations in Mozambique.
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Affiliation(s)
| | - Rachid Muleia
- Instituto Nacional de Saúde, Maputo, P.O. Box 264, Mozambique
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Laher F, Otwombe K, Mokwena O, Bekker LG, Allen M. Use of Varied Screening Risk Criteria and HIV Incidence in Phase 1 and 2 HIV Vaccine Trials in South Africa. AIDS Behav 2023; 27:1314-1320. [PMID: 36287343 PMCID: PMC10038814 DOI: 10.1007/s10461-022-03867-3] [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: 09/14/2022] [Indexed: 11/01/2022]
Abstract
Many early phase HIV prevention studies define HIV risk-related eligibility criteria. We conducted a retrospective review of HIV Vaccine Trials Network (HVTN) Phase 1 and 2 HIV vaccine clinical trials completed in South Africa from 2003 to 2020, evaluating HIV incidence by protocol-defined risk criteria. Comparisons between groups controlled for age, gender and year of trial initiation. Across 12 trials, 1 did not specify risk criteria, and 11 specified various low risk criteria thematically categorized under sexual behaviors, clinical characteristics, and/or drug use behavior. Of the 11 trials, 6 used low sexual risk eligibility criteria standardized by the HVTN in 2009. Of the 1249 participants, median age 23.0 years, 66% were enrolled with the HVTN 2009 standardized low risk criteria, 15% using other sets of low risk criteria, and 19% using no risk criteria. Compared with the standardized low risk criteria group [2.3], HIV incidence per 100 person-years was significantly higher in the non-standardized low risk criteria group [5.0] and in the no risk criteria group [4.8]. In South Africa, cohorts with low HIV incidence can be identified primarily through sexual behavior and clinical characteristics.
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Affiliation(s)
- Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ofentse Mokwena
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mary Allen
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Kim S, Hesseling AC, Wu X, Hughes MD, Shah NS, Gaikwad S, Kumarasamy N, Mitchell E, Leon M, Gonzales P, Badal-Faesen S, Lourens M, Nerette S, Shenje J, de Koker P, Nedsuwan S, Mohapi L, Chakalisa UA, Mngqbisa R, Escada RODS, Ouma S, Heckman B, Naini L, Gupta A, Swindells S, Churchyard G. Factors associated with prevalent Mycobacterium tuberculosis infection and disease among adolescents and adults exposed to rifampin-resistant tuberculosis in the household. PLoS One 2023; 18:e0283290. [PMID: 36930628 PMCID: PMC10022776 DOI: 10.1371/journal.pone.0283290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Understanding factors associated with prevalent Mycobacterium tuberculosis infection and prevalent TB disease in household contacts of patients with drug-resistant tuberculosis (TB) may be useful for TB program staff conducting contact investigations. METHODS Using data from a cross-sectional study that enrolled index participants with rifampin-resistant pulmonary TB and their household contacts (HHCs), we evaluated HHCs age ≥15 years for factors associated with two outcomes: Mycobacterium tuberculosis infection and TB disease. Among HHCs who were not already diagnosed with current active TB disease by the TB program, Mycobacterium tuberculosis infection was determined by interferon-gamma release assay (IGRA). TB disease was adjudicated centrally. We fitted logistic regression models using generalized estimating equations. RESULTS Seven hundred twelve HHCs age ≥15 years enrolled from 279 households in eight high-TB burden countries were a median age of 34 years, 63% female, 22% current smokers and 8% previous smokers, 8% HIV-positive, and 11% previously treated for TB. Of 686 with determinate IGRA results, 471 tested IGRA positive (prevalence 68.8% (95% Confidence Interval: 64.6%, 72.8%)). Multivariable modeling showed IGRA positivity was more common in HHCs aged 25-49 years; reporting prior TB treatment; reporting incarceration, substance use, and/or a period of daily alcohol use in the past 12 months; sharing a sleeping room or more evenings spent with the index participant; living with smokers; or living in a home of materials typical of low socioeconomic status. Forty-six (6.5% (95% Confidence Interval: 4.6%, 9.0%)) HHCs age ≥15 years had prevalent TB disease. Multivariable modeling showed higher prevalence of TB disease among HHCs aged ≥50 years; reporting current or previous smoking; reporting a period of daily alcohol use in the past 12 months; and reporting prior TB treatment. CONCLUSION We identified overlapping and distinct characteristics associated with Mycobacterium tuberculosis infection and TB disease that may be useful for those conducting household TB investigations.
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Affiliation(s)
- Soyeon Kim
- Department of Biostatistics, Frontier Science Foundation, Brookline, Massachusetts, United States of America
| | - Anneke C. Hesseling
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Xingye Wu
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michael D. Hughes
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - N. Sarita Shah
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College CRS and Sassoon General Hospital, BJMC Clinical Research Site, Pune, Maharashtra, India
| | - Nishi Kumarasamy
- Chennai Antiviral Research and Treatment (CART), Infectious Disease Medical Center, Voluntary Health Services, Chennai, India
| | - Erika Mitchell
- Department of Medicine and University of Cape Town Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa
| | - Mey Leon
- Barranco CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Pedro Gonzales
- San Miguel CRS, Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Sharlaa Badal-Faesen
- University of the Witwatersrand CRS, University of the Witwatersrand, Johannesburg, South Africa
| | - Madeleine Lourens
- TASK Applied Science CRS, Brooklyn Chest Hospital, Bellville, South Africa
| | - Sandy Nerette
- Institute of Infectious Diseases and Reproductive Health, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Petra de Koker
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | | | - Lerato Mohapi
- Soweto CRS, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rosie Mngqbisa
- Durban Adult HIV CRS, Enhancing Care Foundation, Durban University of Technology, Durban, South Africa
| | | | - Samuel Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Barbara Heckman
- Frontier Science Foundation, Amherst, New York, United States of America
| | - Linda Naini
- Department of Clinical Research and Bioscience, Social & Scientific Systems, Silver Spring, Maryland, United States of America
| | - Amita Gupta
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Gavin Churchyard
- Aurum Institute, Parktown, South Africa, School of Public Health, University of Witwatersrand, Johannesburg, South Africa, Vanderbilt University, Nashville, Tennessee, United States of America
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de Melo-Martin I, Crystal RG. Primum Non Nocere: Should Gene Therapy Be Used to Prevent Potentially Fatal Disease but Enable Potentially Destructive Behavior? Hum Gene Ther 2021; 32:529-534. [PMID: 33752441 DOI: 10.1089/hum.2021.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) deficiency constitutes one of the most common hereditary enzyme deficiencies, affecting 35% to 40% of East Asians and 8% of the world population. It causes the well-known Asian Alcohol Flush Syndrome, characterized by facial flushing, palpitation, tachycardia, nausea, and other unpleasant feelings when alcohol is consumed. It is also associated with a marked increase in the risk of a variety of serious disorders, including esophageal cancer and osteoporosis. Our recent studies with murine models have demonstrated that a one-time administration of an adeno-associated virus (AAV) gene transfer vector expressing the human ALDH2 coding sequence (AAVrh.10hALDH2) will correct the deficiency state and prevent alcohol-induced abnormalities of the esophagus and bone. If successful in humans, such strategy would reduce the increased risk-associated disorders such as esophageal cancer and osteoporosis, but also prevent the Asian Alcohol Flush Syndrome. This treatment thus raises ethical concerns: although it would potentially prevent fatal disease, it could also allow affected individuals to drink alcohol without suffering the Asian Alcohol Flush Syndrome and, hence, potentially enable personal destructive behavior. Here we explore the ethical arguments against the development of a gene therapy for ALDH2 deficiency and we find them wanting. We contend that development of such treatments is ethically appropriate and should be part and parcel of the solutions offered against the condition.
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Affiliation(s)
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
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Gutema BT, Chuka A, Ayele G, Tariku EZ, Aschalew Z, Baharu A, Degefa N, Gurara MK. Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study. BMC Public Health 2020; 20:1895. [PMID: 33298022 PMCID: PMC7727140 DOI: 10.1186/s12889-020-09998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS). METHODS A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered. RESULTS The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6-14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR = 0.49; 95% C.I: 0.29-0.85] and housewives [AOR = 0.63; 95% C.I: 0.45-0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41-0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46-0.93] compared with 1st quintiles), and climatic zone (midland [AOR = 1.80;95% CI: 1.11-2.93), highland [AOR = 1.95;95% CI: 1.19-3.18] compared with lowland). In addition, tobacco use [AOR = 4.28;95% CI: 3.38-5.43], and khat use [AOR = 4.75; 95% CI: 2.66-8.50) were also associated with heavy episodic drinking among the study participants. CONCLUSIONS More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.
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Affiliation(s)
- Befikadu Tariku Gutema
- School of Public Health, Arba Minch University, P.O.Box 21, Arba Minch, Ethiopia.
- Arba Minch Health and Demographic Surveillance System (HDSS), Arba Minch, Ethiopia.
| | - Adefris Chuka
- CARE Ethiopia Hawassa Project Office, Hawassa, Ethiopia
| | - Gistane Ayele
- School of Public Health, Arba Minch University, P.O.Box 21, Arba Minch, Ethiopia
- Arba Minch Health and Demographic Surveillance System (HDSS), Arba Minch, Ethiopia
| | - Eshetu Zerhun Tariku
- School of Public Health, Arba Minch University, P.O.Box 21, Arba Minch, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Alazar Baharu
- Arba Minch Health and Demographic Surveillance System (HDSS), Arba Minch, Ethiopia
- Department of Computer Science, Arba Minch University, Arba Minch, Ethiopia
| | - Nega Degefa
- School of Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Mekdes Kondale Gurara
- School of Public Health, Arba Minch University, P.O.Box 21, Arba Minch, Ethiopia
- Arba Minch Health and Demographic Surveillance System (HDSS), Arba Minch, Ethiopia
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Wynn A, Rotheram-Borus MJ, Davis E, le Roux I, Almirol E, O’Connor M, Tomlinson M. Identifying fetal alcohol spectrum disorder among South African children at aged 1 and 5 years. Drug Alcohol Depend 2020; 217:108266. [PMID: 32956976 PMCID: PMC7736512 DOI: 10.1016/j.drugalcdep.2020.108266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorders (FASD) are a global health concern. Early intervention mitigates deficits, yet early diagnosis remains challenging. We examined whether children can be screened and meet diagnoses for FASD at 1.5 years compared to 5 years post-birth. METHODS A population cohort of pregnant women in 24 neighborhoods (N = 1258) was recruited and 84.5 %-96 % were reassessed at two weeks post-birth, 0.5 years, 1.5 years, 3 years, and 5 years later. A two-step process was followed to diagnose FASD; first, a paraprofessional screened the children and then a physician evaluated the child. We evaluated FASD symptoms at 1.5 vs. 5 years. We also examined maternal differences in children receiving a positive FASD screening (n = 160) with those who received a negative FASD screening. RESULTS Screening positive for FASD more than doubled from 1.5 years to 5 years (from 6.8 % to 14.8 %). About one quarter of children who screened positive and were evaluated by a physician, were diagnosed as having a FASD. However, half did not complete the 2nd stage screening. Compared to mothers of children with a negative FASD screening, mothers of children with a positive FASD screening were less likely to have a high school education and more likely to have lower incomes, have experienced interpersonal partner violence, and have a depressed mood. Mothers of children who did not follow up for a 2nd stage physician evaluation were more like to live in informal housing compared to those who followed-up (81.3 % vs. 62.5 %, p = 0.014). CONCLUSIONS We found that children can be screened and diagnosed for FASD at 1.5 and 5 years. As FASD characteristics develop over time, repeated screenings are necessary to identify all affected children and launch preventive interventions. Referrals for children to see a physician to confirm diagnosis and link children to care remains a challenge. Integration with the primary healthcare system might mitigate some of those difficulties.
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Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California at San Diego, 9500 Gilman Drive, La Jolla, California 92024 USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Emily Davis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California 90024 USA
| | - Ingrid le Roux
- Philani Child Health and Nutrition Project, Khayelitsha, South Africa
| | - Ellen Almirol
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California 90024 USA
| | - Mary O’Connor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California 90024 USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa,School of Nursing and Midwifery, Queens University, Belfast, UK South Africa
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Ahmed A, Haque T, Rahman MM. Lifestyle Acquired Immunity, Decentralized Intelligent Infrastructures, and Revised Healthcare Expenditures May Limit Pandemic Catastrophe: A Lesson From COVID-19. Front Public Health 2020; 8:566114. [PMID: 33224915 PMCID: PMC7674625 DOI: 10.3389/fpubh.2020.566114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
Throughout history, the human race has often faced pandemics with substantial numbers of fatalities. As the COVID-19 pandemic has now affected the whole planet, even countries with moderate to strong healthcare support and expenditure have struggled to contain disease transmission and casualties. Countries affected by COVID-19 have different demographics, socioeconomic, and lifestyle health indicators. In this context, it is important to find out to what extent these parametric variations are modulating disease outcomes. To answer this, this study selected demographic, socioeconomic, and health indicators e.g., population density, percentage of the urban population, median age, health expenditure per capita, obesity, diabetes prevalence, alcohol intake, tobacco use, case fatality of non-communicable diseases (NCDs) as independent variables. Countries were grouped according to these variables and influence on dependent variables e.g., COVID-19 positive tests, case fatality, and case recovery rates were statistically analyzed. The results suggested that countries with variable median age had a significantly different outcome on positive test rate (P < 0.01). Both the median age (P = 0.0397) and health expenditure per capita (P = 0.0041) showed a positive relation with case recovery. An increasing number of tests per 100 K of the population showed a positive and negative relationship with the number of positives per 100 K population (P = 0.0001) and the percentage of positive tests (P < 0.0001), respectively. Alcohol intake per capita in liter (P = 0.0046), diabetes prevalence (P = 0.0389), and NCDs mortalities (P = 0.0477) also showed a statistical relation to the case fatality rate. Further analysis revealed that countries with high healthcare expenditure along with high median age and increased urban population showed more case fatality but also had a better recovery rate. Investment in the health sector alone is insufficient in controlling the severity of the pandemic. Intelligent and sustainable healthcare both in urban and rural settings and healthy lifestyle acquired immunity may reduce disease transmission and comorbidity induced fatalities, respectively.
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Affiliation(s)
- Asif Ahmed
- Biotechnology and Genetic Engineering Discipline, Khulna University, Khulna, Bangladesh
| | - Tasnima Haque
- Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh
| | - Mohammad Mahmudur Rahman
- Department of Medical Biotechnology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
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Harder VS, Musau AM, Musyimi CW, Ndetei DM, Mutiso VN. A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya. Addiction 2020; 115:1050-1060. [PMID: 31782966 PMCID: PMC8353663 DOI: 10.1111/add.14903] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/06/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023]
Abstract
AIM To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. DESIGN A randomized clinical trial of mobile MI and standard in-person MI with 1- and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. SETTING A primary health center in rural Kenya. PARTICIPANTS Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n = 89), in-person MI (n = 65) or delayed mobile MI (n = 76) for waiting-list controls 1 month after no treatment, with 70 unable to be reached for intervention. INTERVENTION AND COMPARATOR One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1 month and then provided by mobile phone. MEASUREMENTS Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AUDIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1 month after no intervention for waiting-list control versus 1 month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6 months after MI. FINDINGS For our primary outcome, average AUDIT-C scores were nearly three points higher (difference = 2.88, 95% confidence interval = 2.11, 3.66) for waiting-list controls after 1 month of no intervention versus mobile MI 1 month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor = 0.22), but were inconclusive at 6 months (Bayes factor = 0.41). CONCLUSION Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.
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Affiliation(s)
- Valerie S. Harder
- University of Vermont, Departments of Pediatrics and Psychiatry, 1 S. Prospect Street, Burlington, VT, 05401 USA,Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,CORRESPONDING AUTHOR: Valerie S. Harder, PhD, MHS, Associate Professor of Pediatrics and Psychiatry, University of Vermont Larner College of Medicine, 1 S. Prospect Street, Burlington, VT, 05401 USA, , Phone: 802-656-8210
| | - Abednego M. Musau
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya
| | | | - David M. Ndetei
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,University of Nairobi, Department of Psychiatry, P.O. Box 19676-00202, Nairobi, Kenya
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Jernigan DH, Trangenstein PJ. What's next for WHO's global strategy to reduce the harmful use of alcohol? Bull World Health Organ 2020; 98:222-223. [PMID: 32132758 PMCID: PMC7047030 DOI: 10.2471/blt.19.241737] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- David H Jernigan
- Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St., Boston, MA 02118, United States of America (USA)
| | - Pamela J Trangenstein
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
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Mycobacterium Tuberculosis infection among the elderly in 20 486 rural residents aged 50-70 years in Zhongmu County, China. Clin Microbiol Infect 2019; 25:1120-1126. [PMID: 30738995 DOI: 10.1016/j.cmi.2019.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Elderly individuals in rural China have been known to be at increased risk of contracting tuberculosis (TB) and developing active disease. This study aims to estimate the burden of mycobacterium tuberculosis (MTB) infection and to identify potential targeted subgroups for infection control. METHODS As part of the investigation of an interventional study, 50- to 70-year-old rural residents in Zhongmu County were targeted for MTB infection testing using QuantiFERON-TB Gold In-Tube (QFT). Questionnaires and physical examinations were conducted to acquire their demographic information and health status. RESULTS A total of 20 486 individuals were included in the analysis. The prevalence of QFT positivity was 20.79% (4259/20 486) and 50 participants (0.24%) had indeterminate results. A positive dose-response relation was found for QFT positivity with smoking intensity. Compared with non-drinkers, the risk of MTB infection was lower among participants with moderate alcohol consumption (<10 g/day) with adjusted odds ratio (OR) of 0.82 (95% CI 0.71-0.94). In addition, gender of male, with a history of previous TB or silicosis, and hepatitis B/C virus infection were associated with increased risk of MTB infection. An indeterminate QFT result was related to being underweight (adjusted OR 3.18; 95% CI 1.09-9.26). CONCLUSIONS Our results indicate a high burden of MTB infection among the elderly in this rural area. Smokers, individuals with a history of previous TB or silicosis, and those with hepatitis B/C virus infection should be prioritized for MTB infection control to reduce the risk of disease development from a new infection.
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Ezzati M, Pearson-Stuttard J, Bennett JE, Mathers CD. Acting on non-communicable diseases in low- and middle-income tropical countries. Nature 2018; 559:507-516. [DOI: 10.1038/s41586-018-0306-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023]
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12
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Jenkins RA. Getting to Zero: We Can't Do It Without Addressing Substance Use. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:225-231. [PMID: 29969312 DOI: 10.1521/aeap.2018.30.3.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV elimination by 2030 cannot occur without attention to substance use. It cuts across risk groups and affects sexual risk behavior, treatment adherence, and systemic processes such as immunity and inflammation. There continues to be often limited attention to non-injection drug use and the syndemic character of HIV and substance use. There is a need for a more comprehensive approach that addresses the multiple influences of substance use on HIV prevention and care, integrating this into evidence-based services and building on the successes of comprehensive Seek, Test, Treat, and Retain approaches to substantially reducing new HIV cases among drug users.
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13
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Parry CDH, Tomlinson M, Bryant K, Rotherham-Borus MJ. Fresh Perspectives on the Alcohol and HIV Nexus: A Call for Action in an Era of Increased Opportunities and Challenges. AIDS Behav 2017; 21:121-125. [PMID: 28956194 PMCID: PMC5839632 DOI: 10.1007/s10461-017-1917-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Charles D H Parry
- Alcohol Tobacco & Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.
- Department of Psychiatry, Stellenbosch University, PO Box 19070, Tygerberg, 7505, South Africa.
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Kendall Bryant
- HIV/AIDS and Alcohol Research Program, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Mary Jane Rotherham-Borus
- Global Center for Children and Families, Semel Institute and the Department of Psychiatry, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Davis EC, Rotheram-Borus MJ, Weichle TW, Rezai R, Tomlinson M. Patterns of Alcohol Abuse, Depression, and Intimate Partner Violence Among Township Mothers in South Africa Over 5 Years. AIDS Behav 2017; 21:174-182. [PMID: 29027039 PMCID: PMC5839633 DOI: 10.1007/s10461-017-1927-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Alcohol is a major contributor to the global burden of disease. In South Africa, alcohol abuse is hypothesized to correlate with women's HIV status, mental health, and partner relationships over time. All pregnant women in 12 urban, low-income, Cape Town neighborhoods were interviewed at baseline, post-birth, and at 6, 12, 36, and 60 months following delivery with retention rates from 82.5 to 94%. Women were assessed for any alcohol use, problematic drinking, depression, intimate partner violence, and HIV status. Prior to pregnancy discovery and 5 years after giving birth, alcohol use was 25.8 and 24.7%, respectively. Most women decreased their alcohol use during pregnancy. Twenty-one percent reported alcohol use on two or more assessments, and only 15% of the mothers drinking alcohol at 5 years were also drinking at baseline. Mothers with depression had a higher likelihood of drinking alcohol compared to mothers who were not depressed only at baseline and 6 months post-birth. Mothers who experienced IPV had more than twice the likelihood of drinking alcohol compared to non-IPV mothers at all assessments. HIV positive mothers were more likely to drink alcohol compared to mothers without HIV prior to pregnancy discovery and at 5 years post-birth. These longitudinal trends in alcohol use among young women in South Africa represent a large economic, social, and health burden and must be addressed in a comprehensive manner.
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Affiliation(s)
- Emily C Davis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Thomas W Weichle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Roxana Rezai
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch, 7602, South Africa
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15
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Raviglione M, Poznyak V. Targeting harmful use of alcohol for prevention and treatment of tuberculosis: a call for action. Eur Respir J 2017; 50:50/1/1700946. [PMID: 28705947 DOI: 10.1183/13993003.00946-2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/05/2022]
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16
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction 2017; 112:968-1001. [PMID: 28220587 PMCID: PMC5434904 DOI: 10.1111/add.13757] [Citation(s) in RCA: 651] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Campbell Family Mental Health Research Institute, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Gerhard E. Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Alcohol Treatment CenterLausanne University HospitalLausanneSwitzerland
- Addiction SwitzerlandLausanneSwitzerland
- University of the West of EnglandBristolUK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoOntarioCanada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
- Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden
| | - Andriy V. Samokhvalov
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Kevin D. Shield
- Section of Cancer SurveillanceInternational Agency for Research on CancerLyonFrance
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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17
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. ADDICTION (ABINGDON, ENGLAND) 2017. [PMID: 28220587 DOI: 10.1111/add.13757.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Gerhard E Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,University of the West of England, Bristol, UK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Paul A Shuper
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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Rehm J, Probst C, Shield KD, Shuper PA. Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect. Popul Health Metr 2017; 15:4. [PMID: 28183309 PMCID: PMC5301358 DOI: 10.1186/s12963-017-0121-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/24/2017] [Indexed: 12/22/2022] Open
Abstract
In the first part of this review, the nature of the associations between alcohol use and HIV/AIDS is discussed. Alcohol use has been found to be strongly associated with incidence and progression of HIV/AIDS, but the extent to which this association is causal has traditionally remained in question. Experiments where alcohol use has been manipulated as the independent variable have since helped establish a causal effect of alcohol use on the intention to engage in condomless sex. As the intention to engage in condomless sex is a surrogate measure of actual condom use behavior, which itself is linked to HIV incidence and re-infection, the causal chain has been corroborated. Moreover, there are biological pathways between alcohol use and the course of HIV/AIDS, only in part being mediated by adherence to antiretroviral medication. In the second part of the contribution, we provide suggestions on the quantification of the link between alcohol use and HIV incidence, using risk relations derived from experimental data. The biological links between alcohol use and course of HIV/AIDS are difficult to quantify given the current state of knowledge, except for an operationalization for the link via adherence to medication based on meta-analyses. The suggested quantifications are exemplified for South Africa.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8 Canada
- Institute of Medical Science (IMS), University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3 M7 Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3 M7 Canada
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Zuma K, Shisana O, Rehle TM, Simbayi LC, Jooste S, Zungu N, Labadarios D, Onoya D, Evans M, Moyo S, Abdullah F. New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 15:67-75. [PMID: 27002359 DOI: 10.2989/16085906.2016.1153491] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article presents key findings from the 2012 HIV prevalence, incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002, 2005, 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4-13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25-49 years were most affected, 25.2% [95% CI: 23.2-27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8-11.6] in 2008 to 12.2% [95% CI: 11.4-13.1] in 2012 (p < 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p < 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87-1.27], with the highest incidence among Black African females aged 20-34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15-24 years, and was significantly higher among male youth than female (16.7% vs. 5.0% respectively, p < 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p < 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p < 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However, there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical, behavioural, social and structural prevention interventions to reverse the tide in the fight against HIV.
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Affiliation(s)
- Khangelani Zuma
- a Human Sciences Research Council , Pretoria , South Africa.,b Statistics Department , University of South Africa , Pretoria , South Africa
| | - Olive Shisana
- a Human Sciences Research Council , Pretoria , South Africa
| | - Thomas M Rehle
- a Human Sciences Research Council , Pretoria , South Africa.,c Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
| | - Leickness C Simbayi
- a Human Sciences Research Council , Pretoria , South Africa.,d Department of Psychiatry and Mental Health, University of Cape Town , Cape Town South Africa
| | - Sean Jooste
- a Human Sciences Research Council , Pretoria , South Africa
| | | | | | - Dorina Onoya
- a Human Sciences Research Council , Pretoria , South Africa
| | - Meredith Evans
- a Human Sciences Research Council , Pretoria , South Africa
| | - Sizulu Moyo
- a Human Sciences Research Council , Pretoria , South Africa
| | - Fareed Abdullah
- e South African National AIDS Council , Pretoria , South Africa
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20
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Rehm J, Imtiaz S. A narrative review of alcohol consumption as a risk factor for global burden of disease. Subst Abuse Treat Prev Policy 2016; 11:37. [PMID: 27793173 PMCID: PMC5084343 DOI: 10.1186/s13011-016-0081-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/19/2016] [Indexed: 01/09/2023] Open
Abstract
Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, T505, Toronto, ON M5S 2S1 Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8 Canada
- Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, T505, Toronto, ON M5S 2S1 Canada
- Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
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Abstract
Alcohol consumption is a global phenomenon, as is the resultant health, social and economic harm. The nature of these harms varies with different drinking patterns and with the societal and political responses to the burden of harm; nevertheless, alcohol-related chronic diseases have a major effect on health. Strong evidence exists for the effectiveness of different strategies to minimize this damage and those policies that target price, availability and marketing of alcohol come out best, whereas those using education and information are much less effective. However, these policies can be portrayed as anti-libertarian and so viewing them in the context of alcohol-related harm to those other than the drinker, such as the most vulnerable in society, is important. When this strategy is successful, as in Scotland, it has been possible to pass strong and effective legislation, such as for a minimum unit price for alcohol.
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22
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Wandera B, Tumwesigye NM, Nankabirwa JI, Mafigiri DK, Parkes-Ratanshi RM, Kapiga S, Hahn J, Sethi AK. Efficacy of a Single, Brief Alcohol Reduction Intervention among Men and Women Living with HIV/AIDS and Using Alcohol in Kampala, Uganda: A Randomized Trial. J Int Assoc Provid AIDS Care 2016; 16:276-285. [PMID: 27215561 DOI: 10.1177/2325957416649669] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We evaluated the efficacy of a brief motivational intervention (MI) counseling in reducing alcohol consumption among persons living with HIV/AIDS in Kampala, Uganda. Persons living with HIV/AIDS with Alcohol Use Disorders Identification Tool (AUDIT) score ≥3 points were randomized to either standardized positive prevention counseling alone or in combination with alcohol brief MI counseling. The mean change in AUDIT-C scores over 6 months was compared by treatment arm. The mean (standard deviation [SD]) AUDIT-C scores were 6.3 (2.3) and 6.8 (2.3) for control and MI arms ( P = .1) at baseline, respectively, and change in mean AUDIT-C score was not statistically different between arms over the 6 months ( P = .8). However, there was a statistically significant decrease in mean AUDIT-C score (-1.10; 95% confidence interval: -2.19 to -0.02, P = .046) among women in the MI arm. There was a nondifferential reduction in alcohol consumption overall, but MI appeared effective among women only. Studies with more than 1 counseling session and evaluation of gender differences in treatment response are needed.
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Affiliation(s)
- Bonnie Wandera
- 1 Department of epidemiology & Biostatistics, Makerere University School of Public Health, Kampala, Uganda.,4 Infectious Diseases Institute, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- 1 Department of epidemiology & Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - David Kaawa Mafigiri
- 3 Department of Social work and Social administration, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Rosalind M Parkes-Ratanshi
- 4 Infectious Diseases Institute, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Saidi Kapiga
- 5 Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Judith Hahn
- 6 Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Ajay K Sethi
- 7 Department of Population Health Sciences, University of Wiscsonsin School of Medicine and Public Health, Madison, WI, USA
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HIV-Alcohol Risk Reduction Interventions in Sub-Saharan Africa: A Systematic Review of the Literature and Recommendations for a Way Forward. AIDS Behav 2016; 20:484-503. [PMID: 26511865 DOI: 10.1007/s10461-015-1233-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sub-Saharan Africa bears 69 % of the global burden of HIV, and strong evidence indicates an association between alcohol consumption, HIV risk behavior, and HIV incidence. However, characteristics of efficacious HIV-alcohol risk reduction interventions are not well known. The purpose of this systematic review is to summarize the characteristics and synthesize the findings of HIV-alcohol risk reduction interventions implemented in the region and reported in peer-reviewed journals. Of 644 citations screened, 19 met the inclusion criteria for this review. A discussion of methodological challenges, research gaps, and recommendations for future interventions is included. Relatively few interventions were found, and evidence is mixed about the efficacy of HIV-alcohol risk reduction interventions. There is a need to further integrate HIV-alcohol risk reduction components into HIV prevention programming and to document results from such integration. Additionally, research on larger scale, multi-level interventions is needed to identify effective HIV-alcohol risk reduction strategies.
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Eaton LA, Cain DN, Pitpitan EV, Carey KB, Carey MP, Mehlomakulu V, Simbayi LC, Mwaba K, Kalichman SC. Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. J Prim Prev 2015; 35:255-65. [PMID: 24806889 DOI: 10.1007/s10935-014-0346-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol's role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (n = 1,137) and women (n = 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women's alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.
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Affiliation(s)
- Lisa A Eaton
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA,
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Onyeka IN, Olubamwo O, Beynon CM, Ronkainen K, Föhr J, Tiihonen J, Tuomola P, Tasa N, Kauhanen J. Factors associated with hospitalization for blood-borne viral infections among treatment-seeking illicit drug users. J Subst Abuse Treat 2015; 53:71-7. [PMID: 25736625 DOI: 10.1016/j.jsat.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/25/2014] [Accepted: 01/06/2015] [Indexed: 01/24/2023]
Abstract
Blood-borne viral infections (BBVIs) are important health consequences of illicit drug use. This study assessed predictors of inpatient hospital admissions for BBVIs in a cohort of 4817 clients seeking treatment for drug use in Finland. We examined clients' data on hospital admissions registered in the Finnish National Hospital Discharge Register from 1997 to 2010 with diagnoses of BBVIs. Cox proportional hazards regression analyses were separately conducted for each of the three BBVI groups to test for association between baseline variables and hospitalizations. Findings were reported as adjusted hazard ratios (aHRs). Based upon primary discharge diagnoses, 81 clients were hospitalized for HIV, 116 for hepatitis C, and 45 for other types of hepatitis. Compared to those admitted for hepatitis C and other hepatitis, drug users with HIV had higher total number of hospital admissions (294 versus 141 and 50 respectively), higher crude hospitalization rate (7.1 versus 3.4.and 1.2 per 1000 person-years respectively), and higher total length of hospital stay (2857 days versus 279 and 308 respectively). Trends in hospitalization for all BBVI groups declined at the end of follow-up. HIV positive status at baseline (aHR: 6.58) and longer duration of drug use (aHR: 1.11) were independently associated with increased risk for HIV hospitalization. Female gender (aHR: 3.05) and intravenous use of primary drug (aHR: 2.78) were significantly associated with HCV hospitalization. Having hepatitis B negative status at baseline (aHR: 0.25) reduced the risk of other hepatitis hospitalizations. Illicit drug use coexists with blood-borne viral infections. To address this problem, clinicians treating infectious diseases need to also identify drug use in their patients and provide drug treatment information and/or referral.
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Affiliation(s)
- Ifeoma N Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Olubunmi Olubamwo
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Caryl M Beynon
- Independent Research Consultant, Liverpool, United Kingdom
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jaana Föhr
- Helsinki Deaconess Institute, Helsinki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; National Institute for Health and Welfare, Helsinki, Finland; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Niko Tasa
- Helsinki Deaconess Institute, Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Duraisamy K, Mrithyunjayan S, Ghosh S, Nair SA, Balakrishnan S, Subramoniapillai J, Oeltmann JE, Moonan PK, Kumar AMV. Does Alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome? A population-based study in Kerala, India. Ann Am Thorac Soc 2014; 11:712-8. [PMID: 24735096 PMCID: PMC4631605 DOI: 10.1513/annalsats.201312-447oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE India reports the largest number of multidrug-resistant tuberculosis cases in the world; yet, no longitudinal study has assessed factors related to treatment outcomes under programmatic conditions in the public sector. OBJECTIVES To describe demographic, clinical, and risk characteristics associated with treatment outcomes for all patients with multidrug-resistant tuberculosis registered in the Revised National Tuberculosis Control Programme, Kerala State, India from January 1, 2009 to June 30, 2010. METHODS Cox regression methods were used to calculate adjusted hazard ratios with 95% confidence intervals (CIs) to assess factors associated with an unsuccessful treatment outcome. MEASUREMENTS AND MAIN RESULTS Of 179 patients with multidrug-resistant tuberculosis registered, 112 (63%) had successful treatment outcomes (77 bacteriologically cured, 35 treatment completed) and 67 (37%) had unsuccessful treatment outcomes (30 died, 26 defaulted, 9 failed treatment, 1 stopped treatment because of drug-related adverse events, and 1 developed extensively drug-resistant tuberculosis). The hazard for unsuccessful outcome was significantly higher among patients who consumed alcohol during treatment (adjusted hazard ratio, 4.3; 95% CI, 1.1-17.6) than those who did not. Persons who consumed alcohol during treatment, on average, missed 18 more intensive-phase doses (95% CI, 13-22) than those who did not. Although many patients had diabetes (33%), were ever smokers (39%), or had low body mass index (47%), these factors were not associated with outcome. CONCLUSION Overall treatment success was greater than global and national averages; however, outcomes among patients consuming alcohol remained poor. Integration of care for multidrug-resistant tuberculosis and alcoholism should be considered to improve treatment adherence and outcomes.
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Affiliation(s)
| | | | - Smita Ghosh
- U.S. Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia
| | | | - Shibu Balakrishnan
- Department of Tuberculosis, WHO Country Office for India, New Delhi, India
| | | | - John E. Oeltmann
- U.S. Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia
| | - Patrick K. Moonan
- U.S. Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
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Peltzer K, Naidoo P, Louw J, Matseke G, Zuma K, McHunu G, Tutshana B, Mabaso M. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in South Africa: results from a cluster randomized controlled trial. BMC Public Health 2013; 13:699. [PMID: 23902931 PMCID: PMC3733870 DOI: 10.1186/1471-2458-13-699] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 07/29/2013] [Indexed: 11/20/2022] Open
Abstract
Background In 2008 the World Health Organization (WHO) reported that South Africa had the highest tuberculosis (TB) incidence in the world. This high incidence rate is linked to a number of factors, including HIV co-infection and alcohol use disorders. The diagnosis and treatment package for TB and HIV co-infection is relatively well established in South Africa. However, because alcohol use disorders may present more insidiously, making it difficult to diagnose, those patients with active TB and misusing alcohol are not easily cured from TB. With this in mind, the primary purpose of this cluster randomized controlled trial was to provide screening for alcohol misuse and to test the effectiveness of brief interventions in reducing alcohol intake in those patients with active TB found to be misusing alcohol in primary public health care clinics in three districts in South Africa. Methods Within each of the three provinces targeted, one district with the highest TB burden was selected. Furthermore, 14 primary health care facilities with the highest TB caseload in each district were selected. In each district, 7 of the 14 (50%) clinics were randomly assigned to a control arm and another 7 of the 14 (50%) clinics assigned to intervention arm. At the clinic level systematic sampling was used to recruit newly diagnosed and retreatment TB patients. Those consenting were screened for alcohol misuse using the Alcohol Use Disorder Identification Test (AUDIT). Patients who screened positive for alcohol misuse over a 6-month period were given either a brief intervention based on the Information-Motivation-Behavioural Skills (IMB) Model or an alcohol use health education leaflet. Results Of the 4882 tuberculosis patients screened for alcohol and agreed to participate in the trial, 1196 (24.6%) tested positive for the AUDIT. Among the 853 (71%) patients who also attended the 6-month follow-up session, the frequency of positive screening results at baseline/follow-up were 100/21.2% for the AUDIT (P < 0.001) for the control group and 100/16.8% (P < 0.001) for the intervention group. The intervention effect on the AUDIT score was statistically not significant. The intervention effect was also not significant for hazardous or harmful drinkers and alcohol dependent drinkers (AUDIT: 7–40), alcohol dependent drinkers and heavy episodic drinking, while the control group effect was significant for hazardous drinkers (AUDIT: 7–19) (P = 0.035). Conclusion The results suggest that alcohol screening and the provision of a health education leaflet on sensible drinking performed at the beginning of anti-tuberculosis treatment in public primary care settings may be effective in reducing alcohol consumption. Trial registrations PACTR201105000297151
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Affiliation(s)
- Karl Peltzer
- HIV, AIDS, TB, and STIs, Human Sciences Research Council, Pretoria, Cape Town, South Africa.
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Go VF, Minh NL, Frangakis C, Ha TV, Latkin CA, Sripaipan T, Davis W, Zelaya C, Ngoc NP, Quan VM. Decreased injecting is associated with increased alcohol consumption among injecting drug users in northern Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:304-11. [PMID: 23332981 PMCID: PMC4774043 DOI: 10.1016/j.drugpo.2012.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/04/2012] [Accepted: 12/09/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reducing injecting frequency may reduce the risk of HIV infection and improve health outcomes among injection drug users (IDUs). However, the reduction of one risk behavior may be associated with an increase in other risk behaviors, including the use of other risk-associated substances. Our objective was to determine if an association exists between a reduction in injecting and level of alcohol use among IDU. METHODS We conducted a longitudinal analysis of data collected for a randomized controlled trial examining the efficacy of a peer education intervention in reducing HIV risk among IDU and their network members in Thai Nguyen, Vietnam. Our analysis included active male injectors (n = 629) who were study participants and attended both baseline and 3-month visits. Frequency of alcohol consumption was assessed as the number of alcoholic drinks in the past 30 days. Change in risk and outcome behaviors was calculated as the difference in frequencies of behaviors between baseline and 3-month follow-up visits. The outcome of interest was concurrent decreased drug injection and increased alcohol consumption. RESULTS The mean difference between baseline and 3-month follow-up of alcohol consumption and injection frequency in the past 30 days was 19.03 drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively. Participants who reported reduced injection frequency were almost three times as likely to report increased alcohol consumption (OR 2.8; 95% CI, 2.0, 4.0). The proportion that both decreased injecting and increased alcohol by any amount in the past 30 days was 35.6%. In multivariate analysis higher education was significantly associated with an increase in alcohol and decrease in injecting of any amount. CONCLUSION Male IDU may be at risk for increasing alcohol consumption when they reduce injection frequency. Interventions with male IDU that encourage reduction of injection may need to review specific strategies to limit alcohol consumption.
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Affiliation(s)
- Vivian F Go
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD 21205, USA.
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Maguiña JL, Konda KA, Leon SR, Lescano AG, Clark JL, Hall ER, Klausner JD, Coates TJ, Caceres CF. Relationship between alcohol consumption prior to sex, unprotected sex and prevalence of STI/HIV among socially marginalized men in three coastal cities of Peru. AIDS Behav 2013; 17:1724-33. [PMID: 23054035 PMCID: PMC3943345 DOI: 10.1007/s10461-012-0310-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article presents data about the relationship between alcohol consumption prior to sex and unprotected sex and the prevalence of at least one sexually transmitted infection (STI) including HIV among socially marginalized men in three coastal Peruvians cities. During an epidemiological survey with 2,146 men, we assessed their STI prevalence, frequency of alcohol consumption prior to sex, unprotected sex and other sexual risk behaviors. The overall prevalence of at least one STI/HIV was 8.5 % (95 % CI 7.3-9.7), the prevalence of unprotected sex was 79.1 % (95 % CI 77.8-80.3) and alcohol consumption prior to sex with any of the last five sex partners in the previous 6 months was 68.9 % (95 % CI 66.9-70.9). Bivariate and multivariate analysis showed that alcohol consumption of participants or their partners prior to sex were associated with the prevalence of at least one STI, adjusted Prevalence Ratio (aPR) = 1.3 (95 % CI 1.01-1.68). Unprotected sex was significantly associated with alcohol consumption prior to sex when both partners used alcohol, aPR = 1.15 (95 % CI 1.10-1.20) or when either one of them used alcohol aPR = 1.14 (95 % CI 1.09-1.18). These findings concur with previous literature suggesting a relationship between alcohol consumption prior to sex and STI and HIV. These data improve our understanding of this relationship in this context and could be used to enhance STI and HIV prevention strategies for socially marginalized men in Peru.
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Affiliation(s)
- Jorge L. Maguiña
- Unit of Health, Sexuality and Human Development, Cayetano Heredia Peruvian University, Lima, Peru
- Department of Parasitology, US Naval Medical Research Unit 6, Lima, Peru
- Post-graduate School, Cayetano Heredia Peruvian University, Lima, Peru
| | - Kelika A. Konda
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Segundo R. Leon
- Unit of Health, Sexuality and Human Development, Cayetano Heredia Peruvian University, Lima, Peru
- Sexual Health Laboratory, Research and Development Laboratory, Cayetano Heredia Peruvian University, Lima, Peru
| | - Andrés G. Lescano
- Department of Parasitology, US Naval Medical Research Unit 6, Lima, Peru
| | - Jesse L. Clark
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Eric R. Hall
- Naval Medical Research Center, Bethesda, MD, USA
| | - Jeffrey D. Klausner
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Tom J. Coates
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development, Cayetano Heredia Peruvian University, Lima, Peru
- Sexual Health Laboratory, Research and Development Laboratory, Cayetano Heredia Peruvian University, Lima, Peru
- National Institute of Mental Health, Bethesda, MD, USA
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Self-Report of Alcohol Use Increases When Specimens for Alcohol Biomarkers Are Collected in Persons With HIV in Uganda. J Acquir Immune Defic Syndr 2013; 61:e63-4. [PMID: 23138732 DOI: 10.1097/qai.0b013e318267c0f1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parry C, Ferreira-Borges C, Poznyak V, Lönnroth K, Rehm J. The international study on alcohol and infectious diseases: three priorities for research. Addiction 2013; 108:1-2. [PMID: 23075088 DOI: 10.1111/j.1360-0443.2012.04000.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Carina Ferreira-Borges
- Determinants and Risk Factors; Health Promotion Cluster; Regional Office for Africa; World Health Organization; PO BOX 06; Brazzaville; Republic of Congo
| | - Vladimir Poznyak
- Management of Substance Abuse; Department of Mental Health and Substance Abuse; World Health Organization; 20 Avenue Appia; 1211; Geneva 27; Switzerland
| | - Knut Lönnroth
- Stop TB Department; World Health Organization; 20 Avenue Appia; 1211; Geneva 27; Switzerland
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Cogger A, Conover KJ, Israel T. Factors Influencing Alcohol Use Among Sexual Minority Women in a Non-Urban Community: A Mixed Methods Study. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2012. [DOI: 10.1080/15538605.2012.727745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Peltzer K, Louw J, Mchunu G, Naidoo P, Matseke G, Tutshana B. Hazardous and harmful alcohol use and associated factors in tuberculosis public primary care patients in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012. [PMID: 23202681 PMCID: PMC3499864 DOI: 10.3390/ijerph9093245] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess the prevalence of hazardous and harmful alcohol use and associated factors among patients with tuberculosis in South Africa. In a cross-sectional survey new tuberculosis (TB) and TB retreatment patients were consecutively screened using the Alcohol Use Disorder Identification Test (AUDIT) within one month of anti-tuberculosis treatment. The sample included 4,900 (54.5% men and women 45.5%) tuberculosis patients from 42 primary care clinics in three districts. Results indicate that, overall 23.2% of the patients were hazardous or harmful alcohol drinkers, 31.8% of men and 13.0% of women were found to be hazardous drinkers, and 9.3% of men and 3.4% of women meet criteria for probable alcohol dependence (harmful drinking) as defined by the AUDIT. Men had significantly higher AUDIT scores than women. In multivariable analyses it was found that among men poor perceived health status, tobacco use, psychological distress, being a TB retreatment patient and not being on antiretroviral therapy (ART), and among women lower education, tobacco use and being a TB retreatment patient were associated with hazardous or harmful alcohol use. The study found a high prevalence of hazardous or harmful alcohol use among tuberculosis primary care patients. This calls for screening and brief intervention and a comprehensive alcohol treatment programme as a key component of TB management in South Africa.
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Affiliation(s)
- Karl Peltzer
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
- Department of Psychology, University of Limpopo, Turfloop 06854, South Africa
- Author to whom correspondence should be addressed; ; Tel.: +27-12-302-2000; Fax: +27-12-302-2067
| | - Julia Louw
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
| | - Gugu Mchunu
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
| | - Pamela Naidoo
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
- Department of Psychology, University of the Western Cape, Cape Town 8000, South Africa
| | - Gladys Matseke
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
| | - Bomkazi Tutshana
- HIV/STI and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town 8000, South Africa; (J.L.); (G.M.); (P.N.); (G.M.); (B.T.)
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Abstract
Many countries with heavy HIV and alcohol burdens do not fully recognize these epidemics as intrinsically interconnected. Missed opportunities for synergistic prevention and treatment of HIV and alcohol abound.Few HIV policies, services for HIV prevention or research projects adequately address alcohol-HIV harms or include alcohol use as an HIV risk factor.
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Desmond K, Milburn N, Richter L, Tomlinson M, Greco E, van Heerden A, van Rooyen H, Comulada WS, Rotheram-Borus MJ. Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa: prevalence and correlates. Drug Alcohol Depend 2012; 120:113-8. [PMID: 21820252 PMCID: PMC3223298 DOI: 10.1016/j.drugalcdep.2011.07.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 07/07/2011] [Accepted: 07/08/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population. METHODS Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking. RESULTS Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink. CONCLUSION Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation.
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Affiliation(s)
- Katherine Desmond
- Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024 USA
| | - Norweeta Milburn
- Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024 USA
| | - Linda Richter
- Human Sciences Research Council, Durban, Private Bag X07, Dalbridge 4014, South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 South Africa
| | - Erin Greco
- Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024 USA
| | - Alastair van Heerden
- Human Sciences Research Council, Durban, Private Bag X07, Dalbridge 4014, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council, Durban, Private Bag X07, Dalbridge 4014, South Africa
| | - W. Scott Comulada
- Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024 USA
| | - Mary Jane Rotheram-Borus
- Center for Community Health, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024 USA
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Peltzer KK, Naidoo PP, Matseke GG, Zuma KK. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary care clinics in South Africa: a cluster randomized controlled trial protocol. BMC Public Health 2011; 11:394. [PMID: 21615934 PMCID: PMC3120685 DOI: 10.1186/1471-2458-11-394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 05/26/2011] [Indexed: 12/11/2022] Open
Abstract
Background In 2008 the World Health Organization (WHO) reported that South Africa had the highest tuberculosis (TB) incidence in the world. This high incidence rate is linked to a number of factors, including HIV co-infection and alcohol use disorders. The diagnosis and treatment package for TB and HIV co-infection is relatively well established in South Africa. However, because alcohol use disorders may present more insidiously, making it difficult to diagnose, those patients with active TB and misusing alcohol are not easily cured from TB. With this in mind, the primary purpose of this cluster randomized controlled trial is to provide screening for alcohol misuse and to test the efficacy of brief interventions in reducing alcohol intake in those patients with active TB found to be misusing alcohol in primary health care clinics in three provinces in South Africa. Methods/Design Within each of the three selected health districts with the highest TB burden in South Africa, 14 primary health care clinics with the highest TB caseloads will be selected. Those agreeing to participate will be stratified according to TB treatment caseload and the type of facility (clinic or community health centre). Within strata from 14 primary care facilities, 7 will be randomly selected into intervention and 7 to control study clinics (42 clinics, 21 intervention clinics and 21 control clinics). At the clinic level systematic sampling will be used to recruit newly diagnosed TB patients. Those consenting will be screened for alcohol misuse using the AUDIT. Patients who screen positive for alcohol misuse over a 6-month period will be given either a brief intervention based on the Information-Motivation-Behavioural Skills (IMB) Model or an alcohol use health education leaflet. A total sample size of 520 is expected. Discussion The trial will evaluate the impact of alcohol screening and brief interventions for patients with active TB in primary care settings in South Africa. The findings will impact public health and will enable the health ministry to formulate policy related to comprehensive treatment for TB and alcohol misuse, which will result in reduction in alcohol use and ultimately improve the TB cure rates. Trial registration number
PACTR: PACTR201105000297151
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Affiliation(s)
- Karl K Peltzer
- HIV, AIDS, TB, and STIs, Human Sciences Research Council, Pretoria, South Africa.
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Use of AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and sexual behaviour in male sex workers in Kenya. BMC Public Health 2011; 11:384. [PMID: 21609499 PMCID: PMC3128017 DOI: 10.1186/1471-2458-11-384] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 05/25/2011] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Previous research has linked alcohol use with an increased number of sexual partners, inconsistent condom use and a raised incidence of sexually transmitted infections (STIs). However, alcohol measures have been poorly standardised, with many ill-suited to eliciting, with adequate precision, the relationship between alcohol use and sexual risk behaviour. This study investigates which alcohol indicator--single-item measures of frequency and patterns of drinking ( > = 6 drinks on 1 occasion), or the Alcohol Use Disorders Identification Test (AUDIT)--can detect associations between alcohol use and unsafe sexual behaviour among male sex workers. METHODS A cross-sectional survey in 2008 recruited male sex workers who sell sex to men from 65 venues in Mombasa district, Kenya, similar to a 2006 survey. Information was collected on socio-demographics, substance use, sexual behaviour, violence and STI symptoms. Multivariate models examined associations between the three measures of alcohol use and condom use, sexual violence, and penile or anal discharge. RESULTS The 442 participants reported a median 2 clients/week (IQR = 1-3), with half using condoms consistently in the last 30 days. Of the approximately 70% of men who drink alcohol, half (50.5%) drink two or more times a week. Binge drinking was common (38.9%). As defined by AUDIT, 35% of participants who drink had hazardous drinking, 15% harmful drinking and 21% alcohol dependence. Compared with abstinence, alcohol dependence was associated with inconsistent condom use (AOR = 2.5, 95%CI = 1.3-4.6), penile or anal discharge (AOR = 1.9, 95%CI = 1.0-3.8), and two-fold higher odds of sexual violence (AOR = 2.0, 95%CI = 0.9-4.9). Frequent drinking was associated with inconsistent condom use (AOR = 1.8, 95%CI = 1.1-3.0) and partner number, while binge drinking was only linked with inconsistent condom use (AOR = 1.6, 95%CI = 1.0-2.5). CONCLUSIONS Male sex workers have high levels of hazardous and harmful drinking, and require alcohol-reduction interventions. Compared with indicators of drinking frequency or pattern, the AUDIT measure has stronger associations with inconsistent condom use, STI symptoms and sexual violence. Increased use of the AUDIT tool in future studies may assist in delineating with greater precision the explanatory mechanisms which link alcohol use, drinking contexts, sexual behaviours and HIV transmission.
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Townsend L, Rosenthal SR, Parry CDH, Zembe Y, Mathews C, Flisher AJ. Associations between alcohol misuse and risks for HIV infection among men who have multiple female sexual partners in Cape Town, South Africa. AIDS Care 2011; 22:1544-54. [PMID: 20824551 DOI: 10.1080/09540121.2010.482128] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) "Are problem drinkers more likely to have multiple concurrent partners than those who are not?"; (b) "Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not?"; (c) "Are the female sexual partners of problem drinkers different from those who are not?" Two cross-sectional HIV bio-behavioural surveillance surveys using Respondent-Driven Sampling were conducted in two peri-urban settings on the outskirts of Cape Town, South Africa. Eight hundred and forty-eight men aged 25-55 years who have multiple, concurrent female sexual partners were recruited. Problem drinkers had a score of ≥3 on the CAGE questionnaire. Questions enquired about partner numbers, condom use and partner traits. Multivariate logistic regression models were developed to determine significant associations between outcome variables and problem drinking. Fifty-eight percent of men were problem drinkers. Compared to non-problem drinkers, problem drinkers were significantly more likely to report having any symptom of a STI; not using condoms due to drinking; inconsistent condom use with all partner types; that their most recent once-off partner was unemployed; having met their most recent partner at an alcohol-serving venue; and having had a once-off sexual relationship. Alcohol may fuel once-off sexual encounters, often characterised by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV. HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs and multiple sexual partnering are urgently needed.
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Abstract
AIMS To describe three aspects of the epidemiology of alcohol-attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation. DESIGN epidemiological and population health modeling. SETTING Europe. PARTICIPANTS Based on country-specific aggregate statistics. EXPOSURE country-specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics. FINDINGS The absolute risk of dying from an alcohol-attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10 g alcohol per day, the first data point. Over 2/3 of all alcohol-attributable deaths occurring amongst the 20-64 year old population of the European Union (minus Cyprus and Malta) occur in the 45-64 year olds. About 25% of the difference in life expectancy between western and eastern Europe for men aged 20-64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns. CONCLUSIONS Any reduction in the dose of alcohol consumed, at least down to 10 g/day, will reduce the annual and lifetime risk of an alcohol-related death. There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol-related health inequalities, with the specific recommendations for policy depending on the cost-effectiveness of interventions related to the epidemiological profile of the country or region under consideration. Fortunately, there are evidence-based policy options that reduce the amount of alcohol consumed and many alcohol-related harms with immediate effect, that reduce the risk of an alcohol-related death in middle age, and that would help to close the health gap between eastern and western Europe.
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Affiliation(s)
- Jürgen Rehm
- Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany. mail:
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Gmel G, Shield KD, Rehm J. Developing a method to derive alcohol-attributable fractions for HIV/AIDS mortality based on alcohol's impact on adherence to antiretroviral medication. Popul Health Metr 2011; 9:5. [PMID: 21320310 PMCID: PMC3048542 DOI: 10.1186/1478-7954-9-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/14/2011] [Indexed: 12/11/2022] Open
Abstract
Background Alcohol consumption is causally linked to nonadherence to antiretroviral treatment that in turn causes an increase in HIV/AIDS mortality. This article presents a method to calculate the percentage of HIV/AIDS deaths attributable to alcohol consumption and the associated uncertainty. Methods By combining information on risk relations from a number of published sources, we estimated alcohol-attributable fractions (AAFs) of HIV/AIDS in a stepwise procedure. First, we estimated the effect of alcohol consumption on adherence to antiretroviral treatment, and then we combined this estimate with the impact of nonadherence on death. The 95% uncertainty intervals were computed by estimating the variance of the AAFs using Taylor series expansions of one and multiple variables. AAFs were determined for each of the five Global Burden of Disease regions of Africa, based on country-specific treatment and alcohol consumption data from 2005. Results The effects of alcohol on HIV/AIDS in the African Global Burden of Disease regions range from 0.03% to 0.34% for men and from 0% to 0.17% for women, depending on region and age category. The detrimental effect of alcohol consumption was statistically significant in every region and age category except for the North Africa/Middle East region. Conclusions Although the method has its limitations, it was shown to be feasible and provided estimates of the impact of alcohol use on the mortality outcome of HIV/AIDS.
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Affiliation(s)
- Gerrit Gmel
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
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Li Q, Li X, Stanton B. Alcohol use and sexual risk behaviors and outcomes in China: a literature review. AIDS Behav 2010; 14:1227-36. [PMID: 19967440 DOI: 10.1007/s10461-009-9648-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review systematically examines the empirical evidence regarding the association between alcohol use and sexual risk behaviors and outcomes among the Chinese population in mainland, China. Articles published in English (n = 11) and in Chinese (n = 7) from 1980 to 2008 documented consistent associations between alcohol use and several sexual risk behaviors, sexual coercion, sexual violence, and HIV/STIs across both the general population and high-risk groups, except for men having sex with men. This review suggests that alcohol use is associated with diverse sexual risk behaviors and outcomes across a variety of social groups in China, consistent with the evidence from the Western countries and Sub-Saharan Africa. Alcohol use is an important but under-researched correlate of sexual risk behaviors and outcomes in China. This review indicates the importance of research assessing alcohol use among both genders and with standardized measures, and suggests the importance of integrating alcohol use control in sexual risk reduction and prevention efforts in China.
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Affiliation(s)
- Qing Li
- Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI 48201, USA.
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Greenfield TK, Nayak MB, Bond J, Patel V, Trocki K, Pillai A. Validating alcohol use measures among male drinkers in Goa: implications for research on alcohol, sexual risk, and HIV in India. AIDS Behav 2010; 14 Suppl 1:S84-93. [PMID: 20567894 PMCID: PMC2919569 DOI: 10.1007/s10461-010-9734-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Assessment of heavy drinking patterns is vital for HIV/AIDs studies in India and developing countries. A population survey in northern Goa included urban and rural male drinkers (n = 743) who completed a new Fractional Graduated Frequencies (F-GF) alcohol patterns measure assessing seven beverage types and drink sizes for the largest daily amount, then drinking frequencies at fractional amounts. The new measure was compared to a simpler quantity-frequency (QF) summary and, in a validity subsample of hazardous drinkers (n = 56), 28-day diaries of drinking events. Approximately 56% of total volume came from peak drinking (averaging 60 g ethanol/day). For AUDIT-based Hazardous Drinkers, QF and F-GF volumes (drinks/day) were not significantly different from diary volume (correlations 0.65 and 0.57, respectively). F-GF well captured the profile of daily amounts in drinking event data. In addition, the F-GF showed evidence of better predicting any sexual risk behavior or partner violence perpetration than the QF measure. Summary drinking pattern measures, especially the new F-GF, are more cost efficient than intensive event records, and appear valid when carefully assessing quantities with local beverage types and drink ethanol content.
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Affiliation(s)
- Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6475 Christie Ave, Suite 400, Emeryville, CA 94608, USA.
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Rehm J, Baliunas D, Borges GLG, Graham K, Irving H, Kehoe T, Parry CD, Patra J, Popova S, Poznyak V, Roerecke M, Room R, Samokhvalov AV, Taylor B. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction 2010; 105:817-43. [PMID: 20331573 PMCID: PMC3306013 DOI: 10.1111/j.1360-0443.2010.02899.x] [Citation(s) in RCA: 718] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. METHODS Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. RESULTS Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose-response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. CONCLUSIONS Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol-disease relationships.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada.
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Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS--a systematic review. Alcohol Alcohol 2010; 45:159-66. [PMID: 20061510 DOI: 10.1093/alcalc/agp091] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM The study aimed to explore the possible causal nature of the association between alcohol consumption and HIV/AIDS. METHODS A review based on meta-analyses and reviews was conducted according to standard epidemiological criteria to distinguish causality from association, examining (i) the potential impact of alcohol on the incidence of HIV and (ii) alcohol's impact on worsening the disease course. RESULTS In terms of incidence of HIV, although we found a consistent and strong association with consumption, there was not enough evidence for a causal connection. In particular, it is not clear whether personality traits such as sensation seeking or sexual compulsivity and psychiatric disorders such as antisocial personality disorder impact both alcohol consumption and risky sex, subsequently creating an association between both behaviors. In terms of worsening the disease course of HIV/AIDS, we found enough evidence for a causal impact of alcohol. Alcohol affects the immune system, thus contributing to a worsened course of HIV/AIDS. In addition, alcohol negatively impacts on behaviors that include support seeking and medication adherence. CONCLUSIONS A randomized controlled clinical trial targeted toward at-risk HIV-negative individuals who live in areas with high HIV prevalence is suggested to test the effects of proven effective alcohol interventions on HIV incidence.
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Affiliation(s)
- Paul A Shuper
- Centre for Addiction and Mental Health, 33 Russell Street, Room T-518, Toronto, Ontario, Canada M5S 2S1.
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Affiliation(s)
- J Rehm
- Public Health and Regulatory Policy, Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität, Dresden, Germany.
| | - C D Parry
- Alcohol & Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa; Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
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Rehm J, Samokhvalov AV, Neuman MG, Room R, Parry C, Lönnroth K, Patra J, Poznyak V, Popova S. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 2009; 9:450. [PMID: 19961618 PMCID: PMC2796667 DOI: 10.1186/1471-2458-9-450] [Citation(s) in RCA: 257] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 12/05/2009] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship. METHODS A systematic review of existing scientific data on the association between alcohol consumption and TB, and on studies relevant for clarification of causality was undertaken. RESULTS There is a strong association between heavy alcohol use/alcohol use disorders (AUD) and TB. A meta-analysis on the risk of TB for these factors yielded a pooled relative risk of 2.94 (95% CI: 1.89-4.59). Numerous studies show pathogenic impact of alcohol on the immune system causing susceptibility to TB among heavy drinkers. In addition, there are potential social pathways linking AUD and TB. Heavy alcohol use strongly influences both the incidence and the outcome of the disease and was found to be linked to altered pharmacokinetics of medicines used in treatment of TB, social marginalization and drift, higher rate of re-infection, higher rate of treatment defaults and development of drug-resistant forms of TB. Based on the available data, about 10% of the TB cases globally were estimated to be attributable to alcohol. CONCLUSION The epidemiological and other evidence presented indicates that heavy alcohol use/AUD constitute a risk factor for incidence and re-infection of TB. Consequences for prevention and clinical interventions are discussed.
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Affiliation(s)
- Jürgen Rehm
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
- Head WHO Collaboration Centre for Substance Abuse, Zurich, Switzerland
- Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Germany
| | - Andriy V Samokhvalov
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Manuela G Neuman
- In Vitro Drug Safety and Biotechnology, Department of Pharmacology, Institute of Drug Research, University of Toronto, Toronto, Canada
- Centre for International Health, University of Toronto, Toronto, Canada
| | - Robin Room
- School of Population Health, University of Melbourne, Melbourne, Australia
- AER Centre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre, Fitzroy, Victoria, Australia
| | - Charles Parry
- Alcohol & Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Knut Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - Jayadeep Patra
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vladimir Poznyak
- Management of Substance Abuse, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Svetlana Popova
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
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Pithey A, Parry C. Descriptive systematic review of Sub-Saharan African studies on the association between alcohol use and HIV infection. SAHARA J 2009; 6:155-69. [PMID: 20485855 PMCID: PMC11132658 DOI: 10.1080/17290376.2009.9724944] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB Abstracts and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population and alcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence. The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, future research should use prospective study designs, use clearly defined standardised measures of alcohol use (and problematic drinking) and an 'event-specific' approach to examine the situational links between alcohol use and HIV acquisition.
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Affiliation(s)
- Anne Pithey
- Alcohol and Drug Abuse Research Unit (ADARU), South African Medical Research Council (MRC)
| | - Charles Parry
- Alcohol and Drug Abuse Research Unit (ADARU), South African Medical Research Council (MRC)
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Chersich MF, Rees HV, Scorgie F, Martin G. Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa. Global Health 2009; 5:16. [PMID: 19919703 PMCID: PMC2781801 DOI: 10.1186/1744-8603-5-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 11/17/2009] [Indexed: 11/26/2022] Open
Abstract
Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked. Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use. More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives. Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
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Rehm J, Room R. Why do we need International Regulations for Alcohol Control? NORDIC STUDIES ON ALCOHOL AND DRUGS 2009. [DOI: 10.1177/145507250902600411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jürgen Rehm
- Public Health and Regulatory Policy, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public health, University of Toronto, Canada
- Department of Psychiatry, University of Toronto, Canada
- Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität, Dresden, Germany
| | - Robin Room
- School of Population Health, University of Melbourne, Australia
- AER Centre for Alcohol Policy Research, Turning Point Alcohol & Drug Centre, Fitzroy, Victoria, Australia
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden
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Affiliation(s)
- Jürgen Rehm
- Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, ON, Canada
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