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Zhang R, Qiao S, Aggarwal A, Yuan G, Muttau N, Sharma A, Lwatula C, Ngosa L, Kabwe M, Manasyan A, Menon A, Ostermann J, Weissman S, Li X, Harper GW. Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia. Arch Psychiatr Nurs 2024; 48:51-58. [PMID: 38453282 DOI: 10.1016/j.apnu.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18-35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.
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Affiliation(s)
- Ran Zhang
- University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- University of South Carolina, Columbia, South Carolina, USA.
| | | | - Guangzhe Yuan
- University of South Carolina, Columbia, South Carolina, USA
| | - Nobutu Muttau
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Levy Ngosa
- Dignitate Zambia Limited, Lusaka, Zambia
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jan Ostermann
- University of South Carolina, Columbia, South Carolina, USA
| | | | - Xiaoming Li
- University of South Carolina, Columbia, South Carolina, USA
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Kalichman SC, Banas E, Shkembi B, Kalichman M, Mathews C. The three-item patient-reported instrument for retrospective adherence in resource constrained settings: reliability, validity and potential utility. J Behav Med 2024; 47:135-143. [PMID: 37524887 DOI: 10.1007/s10865-023-00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Patient-report instruments remain the most feasible and sustainable approaches for monitoring medication adherence in clinical settings. However, questions of their reliability and validity persist. Studies suggest that the 3-item instrument for retrospective adherence (IRA) developed by Wilson et al. offers a viable option for clinically monitoring medication adherence. Here we report the reliability and validity of the IRA among patients recruited from community-based HIV clinics and antiretroviral therapy (ART) dispensaries in a resource constrained township in Cape Town, South Africa. METHODS Women (n = 794) and men (n = 228) receiving ART completed the IRA at three time points: (a) in a face-to-face administration at enrollment (b) in1-week phone interview and (c) 1-month phone interview. Participants also provided contemporaneous blood samples for HIV viral load testing as a clinical outcome and unannounced phone-based pill counts as an objective assessment of ART adherence. RESULTS The IRA was internally consistent and showed evidence of time stability. The IRA also demonstrated validity with respect to pill count adherence, correlates of adherence, and HIV viral load. Response operating curve analysis yielded an area under the curve of 0.646, using 75% adherence as the cut-off, with 0.637 sensitivity and 0.567 specificity. CONCLUSIONS The IRA demonstrated reliability, construct validity and criterion validity in a resource constrained setting, supporting use of the IRA in research and clinical care.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Ellen Banas
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:50. [PMID: 35794580 PMCID: PMC9258127 DOI: 10.1186/s13011-022-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. Design A cross-sectional survey Setting Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. Participants A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants’ records were reviewed to assess the screening and management of AUD. Results In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). Conclusion While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.
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Mushi D, Francis JM, Moshiro C, Hanlon C, Teferra S. Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review. Front Psychiatry 2022; 13:822791. [PMID: 35370845 PMCID: PMC8964495 DOI: 10.3389/fpsyt.2022.822791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa. Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap. Integrating services for mental, neurological, and substance use disorders in general health care settings is among the recommended strategies to narrow this treatment gap. This scoping review aimed to map the available evidence on integration of AUD interventions in general health care settings in sub-Saharan Africa. METHODS We searched four databases (PubMed, PsycINFO, CINAHL, and Africa Wide Information) for publications up to December 2020. The search strategy focused on terms for alcohol use, alcohol interventions, and sub-Saharan African countries. Studies that reported AUD interventions in general health care settings in sub-Saharan Africa were eligible for inclusion. Over 3,817 potentially eligible articles were identified. After the removal of duplicates and screening of abstracts, 56 articles were included for full article review. Of these, 24 papers reporting on 22 studies were eligible and included in a narrative review. RESULTS Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities, and 2 (8%) studies reported on AUD interventions integrated into general health care settings. CONCLUSIONS This review shows that there is limited evidence on the integration of AUD interventions in health care settings in sub-Saharan Africa. There is an urgent need for studies that report systematically on the development, adaptation, implementation, and evaluation of integrated AUD interventions in health care settings in sub-Saharan Africa.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, Witwatersrand University, Johannesburg, South Africa.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Service and Population Research Department and WHO Collaborating Centre for Mental Health and Training, Institute of Psychiatry, Psychology, and Neuroscience, King's College University, London, United Kingdom
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Asombang M, Helova A, Chipungu J, Sharma A, Wandeler G, Kane JC, Turan JM, Smith H, Vinikoor MJ. Alcohol reduction outcomes following brief counseling among adults with HIV in Zambia: A sequential mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000240. [PMID: 36962202 PMCID: PMC10021288 DOI: 10.1371/journal.pgph.0000240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
Data from sub-Saharan Africa on the impact of alcohol on the HIV epidemic in sub-Saharan Africa is limited. In this region, it is not well understood how people with HIV (PLWHA) respond to alcohol reduction counseling while they are linked to HIV clinical care. We conducted an explanatory sequential mixed-methods study to understand patterns of alcohol use among adults (18+ years) within a prospective HIV cohort at two urban public-sector clinics in Zambia. At antiretroviral therapy (ART) start and one year later, we measured alcohol use with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and those reporting any alcohol use were provided brief counseling. We conducted focus groups at 1 year with participants who had any alcohol use and 20 in-depth interviews among the subgroup with unhealthy use pre-ART and who either reduced or did not reduce their use by 1 year to moderate levels or abstinence. Focus group Discussions (FGDs) (n = 2) were also held with HIV clinic staff. Qualitative data were analyzed using thematic analysis. The data obtained from 693 participants was analyzed (median age 34 years, 45% men), it revealed that unhealthy alcohol use (AUDIT-C >3 for men; >2 for women) was reported among 280 (40.4%) at baseline and 205 (29.6%) at 1 year on ART. Reduction from unhealthy to moderate use or abstinence was more common with older age, female, non-smoking, and at Clinic B (all P<0.05). Qualitative data revealed ineffective alcohol support at clinics, social pressures in the community to consume alcohol, and unaddressed drivers of alcohol use including poverty, poor health status, depression, and HIV stigma. Healthcare workers reported a lack of training in alcohol screening and treatment, which led to mixed messages provided to patients ('reduce to safe levels' versus 'abstain'). In summary, interventions to reduce unhealthy alcohol use are needed within HIV clinics in Zambia as a substantial population have persistent unhealthy use despite current HIV clinical care. A better understanding is needed regarding the implementation challenges related to screening for unhealthy alcohol use integrated with HIV services.
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Affiliation(s)
- Mah Asombang
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anna Helova
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Gilles Wandeler
- Department of Infectious Diseases and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jeremy C Kane
- Columbia University Mailman School of Public Health, New York City, NY, United States of America
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Helen Smith
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Michael J Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
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El-Krab R, Kalichman SC. Alcohol-Antiretroviral Therapy Interactive Toxicity Beliefs and Intentional Medication Nonadherence: Review of Research with Implications for Interventions. AIDS Behav 2021; 25:251-264. [PMID: 33950339 DOI: 10.1007/s10461-021-03285-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
The successful treatment of HIV infection relies on adherence to antiretroviral therapy (ART). Alcohol use remains a threat to ART adherence, including the beliefs held by people who drink alcohol that it is harmful to take ART when consuming alcohol (i.e., alcohol-ART interactive toxicity beliefs, AA-ITB). We reviewed the current research that has investigated AA-ITB and their relationship to intentional ART nonadherence. The review of 17 published studies found that AA-ITB are prevalent among people receiving ART and that AA-ITB are directly associated with ART nonadherence and incomplete HIV suppression. Family, friends and healthcare providers are common sources and reinforcers of AA-ITB. Studies suggest that AA-ITB may best be explained by the Medication Necessity and Concerns Beliefs Model, treating AA-ITB as a specific circumstance of medication concerns. Interventions are needed to communicate the realities of potential medication interactions and dispel myths that it is harmful to mix alcohol with ART, while not inadvertently suggesting that it is safe to drink with all medications, which could undermine adherence to ART by increasing alcohol use.
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Affiliation(s)
- Renee El-Krab
- Institute for Collaboration On Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA
| | - Seth C Kalichman
- Institute for Collaboration On Health Intervention and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, USA.
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Staton CA, Zhao D, Ginalis EE, Hirshon JM, Sakita F, Swahn MH, Mmbaga BT, Vissoci JRN. Alcohol Availability, Cost, Age of First Drink, and Its Association with At-Risk Alcohol Use in Moshi, Tanzania. Alcohol Clin Exp Res 2020; 44:2266-2274. [PMID: 32944986 PMCID: PMC7680393 DOI: 10.1111/acer.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Kilimanjaro region has one of the highest levels of reported alcohol intake per capita in Tanzania. Age at first drink has been found to be associated with alcohol problems in adulthood, but there is less information on the age of first drink in the Kilimanjaro region and its associations with alcohol-related consequences later in life. Furthermore, local alcohol cost and availability may influence the prevalence of alcohol use and alcohol use disorders. METHODS Data on the age of first drink, alcohol use disorder identification tool (AUDIT), number and type of alcohol consequences (DrInC), and perceived alcohol at low cost and high availability for children and adolescents were collected from an alcohol and health behavior survey of injury patients (N = 242) in Moshi, Tanzania. Generalized linear models were used to test age at first drink, perceived alcohol cost and availability, and their association with the AUDIT and DrInC scores, and current alcohol use, respectively. RESULTS Consuming alcohol before age 18 was significantly associated with higher AUDIT and DrInC scores, with odds ratios of 1.22 (CI: 1.004, 1.47) and 1.72 (CI: 1.11, 2.63), respectively. Female gender is strongly associated with less alcohol use and alcohol consequences, represented by an odds ratio of 3.70 (CI: 1.72, 8.33) for an AUDIT score above 8 and an odds ratio of 3.84 (CI: 2.13, 6.67) with the DrInC score. Perceived high availability of alcohol for children is significantly related to higher alcohol use quantity, with the odds ratio of 1.6 (CI: 1.17, 2.20). CONCLUSIONS The first use of alcohol before the age of 18 is associated with higher alcohol use and alcohol-related adverse consequences. In Tanzania, age at first drink is an important target for interventions aiming to prevent negative alcohol-related consequences later in life.
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Affiliation(s)
| | - Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu China
| | | | - Jon Mark Hirshon
- University of Maryland School of Medicine, College Park, Maryland USA
| | | | | | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Kalichman SC, Mathews C, Banas E, Kalichman MO. Alcohol-related beliefs and non-adherence to antiretroviral therapy in Cape Town, South Africa. J Behav Med 2020; 43:764-772. [PMID: 31955306 DOI: 10.1007/s10865-020-00135-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
The life-saving effects of antiretroviral therapy (ART) in treating HIV infection are compromised by alcohol use. A growing body of research shows that both unintentional (e.g., memory lapses) and intentional (e.g., forgoing ART to avoid mixing with alcohol) contribute to ART non-adherence. Beliefs that it is harmful to mix alcohol with ART (alcohol-ART interactive toxicity beliefs) contribute to intentional non-adherence, but their role in overall adherence is not clear. This study conducted a clinic-based survey with 100 men and 193 women (mean age = 36) to examine the prevalence of alcohol-ART interactive toxicity beliefs and whether they contribute to treatment non-adherence in South Africa. One in three (36%, n = 106) participants reported no current alcohol use and 64% (n = 187) reported current alcohol use. The majority of participants, including current alcohol drinkers, endorsed beliefs that it is harmful to mix ART and alcohol, with 57% who currently drink reporting that they forgo taking ART when they are drinking. Participants reported being warned not to mix alcohol and ART from family, friends, and health care providers. In addition, 62% of participants who do not drink, as well as 36% of those who do drink, tell others not to mix alcohol and ART. Mediation modelling found that alcohol use directly predicts ART adherence, and that this relationship is partially mediated by alcohol-ART interactive toxicity beliefs. Health care providers can play a critical role in disputing interactive toxicity beliefs and encouraging patients to take ART even when they are drinking.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ellen Banas
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Moira O Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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Kalichman S, Mathews C, Banas E, Kalichman M. Alcohol-related intentional nonadherence to antiretroviral therapy among people living with HIV, Cape Town, South Africa. AIDS Care 2019; 31:951-957. [PMID: 30884956 DOI: 10.1080/09540121.2019.1587357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Alcohol use may have significant negative impacts on individuals' ability to remain adherent to antiretroviral therapy (ART), and may also yield other negative psychosocial, health-related, and behavioral outcomes. In addition, false beliefs about the consequences of mixing alcohol with ART use may cause individuals to avoid taking ART when drinking (alcohol-related ART avoidance). Although research conducted in the U.S. and Europe has reported on alcohol-ART avoidance, the current study presents among the first quantitative evidence of alcohol-related intentional ART nonadherence in South Africa. Patients receiving ART from a community clinic in Cape Town (N = 441) completed anonymous surveys of alcohol use, ART adherence, and alcohol-ART avoidance. Results showed that 292 (66%) participants reported current alcohol use; 25% who use alcohol believed that people who drink should stop taking ART when they are drinking and 24% stop their own ART when drinking. Alcohol-ART avoidance mediated the association between alcohol use and ART adherence. Results were robust when controlling for participant age, gender, current care status, and first- versus second-line ART. We found alcohol-ART avoidance may threaten successful ART in South Africa. Corrective messages that take a harm reduction approach to maximize ART adherence when drinking should be implemented in existing clinical services.
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Affiliation(s)
- Seth Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Catherine Mathews
- b Health Systems Research Unit , Medical Research Council , Cape Town , South Africa
| | - Ellen Banas
- a Department of Psychology , University of Connecticut , Storrs , CT , USA.,b Health Systems Research Unit , Medical Research Council , Cape Town , South Africa
| | - Moira Kalichman
- a Department of Psychology , University of Connecticut , Storrs , CT , USA
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Nouaman MN, Vinikoor M, Seydi M, Ekouevi DK, Coffie PA, Mulenga L, Tanon A, Egger M, Dabis F, Jaquet A, Wandeler G. High prevalence of binge drinking among people living with HIV in four African countries. J Int AIDS Soc 2018; 21:e25202. [PMID: 30549445 PMCID: PMC6294116 DOI: 10.1002/jia2.25202] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Excessive alcohol consumption leads to unfavourable outcomes in people living with HIV (PLHIV), including reduced adherence to antiretroviral therapy (ART) and engagement into care. However, there is limited information on alcohol consumption patterns among PLHIV in sub-Saharan Africa. METHODS Using a cross-sectional approach, the Alcohol Use Disorders Identification Test (AUDIT-C) was administered to PLHIV attending HIV clinics in Côte d'Ivoire, Togo, Senegal and Zambia (2013 to 2015). Hazardous drinking was defined as an AUDIT-C score ≥4 for men or ≥3 for women, and binge drinking as ≥6 drinks at least once per month. The prevalence of binge drinking was compared to estimates from the general population using data from the World Health Organization. Factors associated with binge drinking among persons declaring any alcohol use in the past year were assessed using a logistic regression model to estimate odds ratio (OR) and their corresponding 95% confidence intervals (CI). RESULTS Among 1824 PLHIV (median age 39 years, 62.8% female), the prevalence of hazardous alcohol use ranged from 0.9% in Senegal to 38.4% in Zambia. The prevalence of binge drinking ranged from 14.3% among drinkers in Senegal to 81.8% in Zambia, with higher estimates among PLHIV than in the general population. Male sex (OR 2.4, 95% CI 1.6 to 3.7), tobacco use (OR 1.7, 95% CI 1.0 to 2.9) and living in Zambia were associated with binge drinking. CONCLUSIONS Alcohol consumption patterns varied widely across settings and binge drinking was more frequent in HIV-positive individuals compared to the general population. Interventions to reduce excessive alcohol use are urgently needed to optimize adherence in the era of universal ART.
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Affiliation(s)
| | - Michael Vinikoor
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Centre for Infectious Disease Research in Zambia (CIDRZ)LusakaZambia
| | - Moussa Seydi
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
| | - Didier K Ekouevi
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
- Département de santé publiqueFaculté des Sciences de la santéUniversité de LoméLoméTogo
| | - Patrick A Coffie
- Programme PACCICHU de TreichvilleAbidjanCôte d'Ivoire
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Lloyd Mulenga
- University Teaching HospitalLusakaZambia
- Zambia Ministry of HealthLusakaZambia
| | - Aristophane Tanon
- CHU de TreichvilleService de maladies infectieuses et tropicalesAbidjanCôte d'Ivoire
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Diseases Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - François Dabis
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Antoine Jaquet
- INSERM U1219 Bordeaux Population Health ResearchISPEDUniversité de BordeauxBordeauxFrance
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicalesCRCF, CHU de FannDakarSénégal
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
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Blair AH, Pearce ME, Katamba A, Malamba SS, Muyinda H, Schechter MT, Spittal PM. The Alcohol Use Disorders Identification Test (AUDIT): Exploring the Factor Structure and Cutoff Thresholds in a Representative Post-Conflict Population in Northern Uganda. Alcohol Alcohol 2018; 52:318-327. [PMID: 28003244 DOI: 10.1093/alcalc/agw090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Despite increased use of the Alcohol Use Disorders Identification Test (AUDIT) in sub-Saharan Africa, few studies have assessed its underlying conceptual framework, and none have done so in post-conflict settings. Further, significant inconsistencies exist between definitions used for problematic consumption. Such is the case in Uganda, facing one of the highest per-capita alcohol consumption levels regionally, which is thought to be hindering rebuilding in the North after two decades of civil war. This study explores the impact of varying designation cutoff thresholds in the AUDIT as well as its conceptual factor structure in a representative sample of the population. Methods In all, 1720 Cango Lyec Project participants completed socio-economic and mental health questionnaires, provided blood samples and took the AUDIT. Participant characteristics and consumption designations were compared at AUDIT summary score thresholds of ≥3, ≥5 and ≥8. Confirmatory factor analyses (CFA) explored one-, two- and three-factor level models overall and by sex with relative and absolute fit indicators. Results There were no significant differences in participant demographic characteristics between thresholds. At higher cutoffs, the test increased in specificity to identify those with hazardous drinking, disordered drinking and suffering from alcohol-related harms. All conceptual models indicated good fit, with three-factor models superior overall and within both sexes. Conclusion In Northern Uganda, a three-factor AUDIT model best explores alcohol use in the population and is appropriate for use in both sexes. Lower cutoff thresholds are recommended to identify those with potentially disordered drinking to best plan effective interventions and treatments. Short summary A CFA of the AUDIT showed good fit for one-, two, and three-factor models overall and by sex in a representative sample in post-conflict Northern Uganda. A three-plus total AUDIT cutoff score is suggested to screen for hazardous drinking in this or similar populations.
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Affiliation(s)
- Alden Hooper Blair
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9 Canada.,Global Health Sciences Program, University of California San Francisco, 550 16th Street, Third Floor, San Francisco, CA 94158, USA
| | - Margo Ellen Pearce
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
| | - Achilles Katamba
- Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - Samuel S Malamba
- HIV Reference Laboratory Program, Uganda Virus Research Institute (UVRI), Plot 51-59 Nakiwongo Road, Entebbe, Uganda
| | - Herbert Muyinda
- Makerere University Child Health Development Center, Upper Mulago Hospital Complex, Kampala, Uganda
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
| | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
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12
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Li L, Uyei J, Nucifora KA, Kessler J, Stevens ER, Bryant K, Braithwaite RS. Using value of information methods to determine the optimal sample size for effectiveness trials of alcohol interventions for HIV-infected patients in East Africa. BMC Health Serv Res 2018; 18:590. [PMID: 30064428 PMCID: PMC6069863 DOI: 10.1186/s12913-018-3356-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Unhealthy alcohol consumption exacerbates the HIV epidemic in East Africa. Potential benefits of new trials that test the effectiveness of alcohol interventions could not be evaluated by traditional sampling methods. Given the competition for health care resources in East Africa, this study aims to determine the optimal sample size given the opportunity cost of potentially re-allocating trial funds towards cost-effective alcohol treatments. Methods We used value of information methods to determine the optimal sample size by maximizing the expected net benefit of sampling for a hypothetical 2-arm intervention vs. control randomized trial, across ranges of policymaker’s willingness-to-pay for the health benefit of an intervention. Probability distributions describing the relative likelihood of alternative trial results were imputed based on prior studies. In the base case, policymaker’s willingness-to-pay was based on a simultaneously resource-constrained priority (routine HIV virological testing). Sensitivity analysis was performed for various willingness-to-pay thresholds and intervention durations. Results A new effectiveness trial accounting for the benefit of more precise decision-making on alcohol intervention implementation would benefit East Africa $67,000 with the optimal sample size of 100 persons per arm under the base case willingness-to-pay threshold and intervention duration of 20 years. At both a conservative willingness-to-pay of 1 x GDP/capita and a high willingness-to-pay of 3 x GDP/capita for an additional health gain added by an alcohol intervention, a new trial was not recommended due to limited decision uncertainty. When intervention duration was 10 or 5 years, there was no return on investment across suggested willingness-to-pay thresholds. Conclusions Value of information methods could be used as an alternative approach to assist the efficient design of alcohol trials. If reducing unhealthy alcohol use is a long-term goal for HIV programs in East Africa, additional new trials with optimal sample sizes ranging from 100 to 250 persons per arm could save the opportunity cost of implementing less cost-effective alcohol strategies in HIV prevention. Otherwise, conducting a new trial is not recommended.
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Affiliation(s)
- Lingfeng Li
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Jennifer Uyei
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kimberly A Nucifora
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA.
| | - Jason Kessler
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Elizabeth R Stevens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
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13
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Adong J, Lindan C, Fatch R, Emenyonu NI, Muyindike WR, Ngabirano C, Winter MR, Lloyd-Travaglini C, Samet JH, Cheng DM, Hahn JA. The Relationship Between Spirituality/Religiousness and Unhealthy Alcohol Use Among HIV-Infected Adults in Southwestern Uganda. AIDS Behav 2018; 22:1802-1813. [PMID: 28555316 PMCID: PMC5708153 DOI: 10.1007/s10461-017-1805-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
HIV and alcohol use are two serious and co-existing problems in sub-Saharan Africa. We examined the relationship between spirituality and/or religiousness (SR) and unhealthy alcohol use among treatment-naïve HIV-infected adults attending the HIV clinic in Mbarara, Uganda. Unhealthy alcohol was defined as having either an alcohol use disorders identification test-consumption score of ≥4 for men or ≥3 for women, or having a phosphatidylethanol level of ≥50 ng/ml based on analysis of dried bloodspot specimens. Of the 447 participants, 67.8% were female; the median age was 32 years (interquartile range [IQR] 27-40). About half reported being Protestant (49.2%), 35.1% Catholic, and 9.2% Muslim. The median SR score was high (103 [IQR 89-107]); 43.3% drank at unhealthy levels. Higher SR scores were associated with lower odds of unhealthy drinking (adjusted odds ratio [aOR]: 0.83 per standard deviation [SD] increase; 95% confidence interval [CI] 0.66-1.03). The "religious behavior" SR subscale was significantly associated with unhealthy alcohol use (aOR: 0.72 per SD increase; 95% CI 0.58-0.88). Religious institutions, which facilitate expression of religious behavior, may be helpful in promoting and maintaining lower levels of alcohol use.
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Affiliation(s)
- Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Christina Lindan
- Department of Medicine, University of California, San Francisco, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, USA
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Jeffrey H Samet
- School of Public Health, Boston University, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Debbie M Cheng
- School of Public Health, Boston University, Boston, MA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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14
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de Vocht F, Brown J, Beard E, West R, Michie S, Campbell R, Hickman M. Motivation to reduce alcohol consumption and subsequent attempts at reduction and changes in consumption in increasing and higher-risk drinkers in England: a prospective population survey. Addiction 2018; 113:817-827. [PMID: 29368391 PMCID: PMC5947299 DOI: 10.1111/add.14132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/18/2017] [Accepted: 12/01/2017] [Indexed: 01/06/2023]
Abstract
AIMS To assess how far motivation to reduce alcohol consumption in increasing and higher-risk drinkers in England predicts self-reported attempts to reduce alcohol consumption and changes in alcohol intake during the following 6 months. METHODS This study used self-reported data from 2928 higher-risk drinkers in the Alcohol Toolkit Study (ATS): a series of monthly cross-sectional household surveys of adults aged 16+ years of age in England. Alcohol consumption was measured in an initial survey and in a 6-month telephone follow-up interview using the Alcohol Use Disorders Identification Test (AUDIT)-C questionnaire. Motivation was measured in the initial survey using the Motivation to Reduce Alcohol Consumption (MRAC) scale. Attempts to reduce alcohol consumption during the past 6 months were recorded at follow-up. Data were analysed using repeated-measures difference-in-differences and logistic regression models. RESULTS Participants with higher initial motivation to reduce alcohol consumption were more likely to report that they had made an attempt to reduce consumption at follow-up [adjusted odds ratio (ORadj ) = 2.39, 95% confidence interval (CI) = 1.75-3.29]. There was an overall reduction in alcohol consumption between initial survey and follow-up (ORadj = 0.72, 95% CI = 0.65-0.79), but there was insufficient evidence of an additional effect of motivation to reduce consumption on subsequent changes in alcohol consumption, with the difference-in-differences effect instead suggesting an average increase (ORadj = 1.37, 95% CI = 1.00-1.88). CONCLUSIONS Increasing and higher-risk drinkers in England who report greater motivation to reduce their consumption are more likely to report making an attempt to reduce during the next 6 months, but this may not be associated with a reduction in alcohol consumption.
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Affiliation(s)
- Frank de Vocht
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Jamie Brown
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Emma Beard
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Susan Michie
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Rona Campbell
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Matthew Hickman
- NIHR School for Public Health Research (SPHR)Newcastle upon TyneUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
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15
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Vinikoor MJ, Sinkala E, Chilengi R, Mulenga LB, Chi BH, Zyambo Z, Hoffmann CJ, Saag MS, Davies MA, Egger M, Wandeler G. Impact of Antiretroviral Therapy on Liver Fibrosis Among Human Immunodeficiency Virus-Infected Adults With and Without HBV Coinfection in Zambia. Clin Infect Dis 2018; 64:1343-1349. [PMID: 28158504 DOI: 10.1093/cid/cix122] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background We investigated changes in hepatic fibrosis, based on transient elastography (TE), among human immunodeficiency virus (HIV)-infected patients with and without hepatitis B virus (HBV) coinfection on antiretroviral therapy (ART) in Zambia. Methods Patients' liver stiffness measurements (LSM; kiloPascals [kPa]) at ART initiation were categorized as no or minimal fibrosis (equivalent to Metavir F0-F1), significant fibrosis (F2-F3), and cirrhosis (F4). TE was repeated following 1 year of ART. Stratified by HBV coinfection status (hepatitis B surface antigen positive at baseline), we described LSM change and the proportion with an increase/decrease in fibrosis category. Using multivariable logistic regression, we assessed correlates of significant fibrosis/cirrhosis at 1 year on ART. Results Among 463 patients analyzed (61 with HBV coinfection), median age was 35 years, 53.7% were women, and median baseline CD4+ count was 240 cells/mm3. Nearly all (97.6%) patients received tenofovir disoproxil fumarate-containing ART, in line with nationally recommended first-line treatment. The median LSM change was -0.70 kPa (95% confidence interval, -3.0 to +1.7) and was similar with and without HBV coinfection. Significant fibrosis/cirrhosis decreased in frequency from 14.0% to 6.7% (P < .001). Increased age, male sex, and HBV coinfection predicted significant fibrosis/cirrhosis at 1 year (all P < .05). Conclusion The percentage of HIV-infected Zambian adults with elevated liver stiffness suggestive of significant fibrosis/cirrhosis decreased following ART initiation-regardless of HBV status. This suggests that HIV infection plays a role in liver inflammation. HBV-coinfected patients were more likely to have significant fibrosis/cirrhosis at 1 year on ART. Clinical Trials Registration NCT02060162.
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Affiliation(s)
- Michael J Vinikoor
- Department of Medicine, University of Alabama at Birmingham.,Centre for Infectious Disease Research in Zambia.,School of Medicine, University of Zambia, and
| | - Edford Sinkala
- School of Medicine, University of Zambia, and.,Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Lloyd B Mulenga
- School of Medicine, University of Zambia, and.,Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Zude Zyambo
- Centre for Infectious Disease Research in Zambia
| | | | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
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16
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Factors Associated With Prevalent HIV Infection Among Kenyan MSM: The Anza Mapema Study. J Acquir Immune Defic Syndr 2017; 76:241-249. [PMID: 28746167 DOI: 10.1097/qai.0000000000001512] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To inform future HIV treatment and care programs for men who have sex with men (MSM), we assessed the prevalence of and factors associated with previously diagnosed HIV-positive and out-of-care (PDOC) or newly diagnosed HIV-positive and out-of-care (NDOC) HIV infection among MSM enrolled in the prospective Anza Mapema cohort study. METHODS Participants were aged 18 years and older, reported oral or anal sex with a man in the past 6 months and were not already in HIV care or taking antiretroviral therapy in the past 3 months. At enrollment, men were tested for HIV infection and completed questionnaires through audio computer-assisted self-interview. Multinomial logistic regression was used to identify associations with PDOC or NDOC HIV infection, relative to HIV-negative status. RESULTS Among 711 enrolled men, 75 (10.5%) were seropositive including 21 PDOC and 54 NDOC men. In multivariable modeling, PDOC status was more likely than HIV-negative status among men who had experienced upsetting sexual experiences during childhood, had recently experienced MSM trauma, and did not report harmful alcohol use. NDOC infection status was more common among men aged 30 years and older and who had completed ≤8 years of education, relative to HIV-negative status. CONCLUSIONS Most HIV-positive men were unaware of their infection, indicating that HIV testing and counseling services tailored to this population are needed. To improve linkage to and retention in care, HIV testing and care services for MSM should screen and provide support for those with hazardous alcohol use and those who have experienced childhood sexual abuse or MSM trauma.
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17
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Mwiru RS, Nagu TJ, Kaduri P, Fawzi W, Mugusi F. Prevalence and factors associated with alcohol drinking among HIV and tuberculosis co-infected patients in Dar es Salaam, Tanzania. AIDS Care 2017; 30:173-177. [PMID: 28670967 DOI: 10.1080/09540121.2017.1344183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is scarcity of information on the burden of alcohol use among people living with HIV in Tanzania despite the high burden of HIV. We examined the prevalence and factors associated with alcohol use among HIV and tuberculosis (TB) co-infected patients in fourteen clinics with highest notification of TB in Dar es Salaam, Tanzania, between October 2010 and December 2011. Proportions were used to describe the prevalence and pattern of alcohol use. Logistic regression was used to assess the association of various participant characteristics with alcohol use. Out of the 515 participants, 38 (7.4%) were current alcohol drinkers, 183 (35.5%) were ex-drinkers and the rest, 294 (57.1%) denied ever drinking alcohol. Approximately, 15% of past and current drinkers were classified as heavy drinkers. Patients with normal BMI, cigarette smokers, and those with higher income were more likely to be drinkers. Similarly, compared to civil servants, those in petty trade and other occupations were more likely to be drinkers. We concluded that, the level of current alcohol use among HIV positive people receiving pulmonary TB treatment in this population was low. Nevertheless, alcohol use screening and assessment should be added as an integral part of service provision in HIV clinics given the effect of alcohol on health outcomes among HIV positive patients.
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Affiliation(s)
| | - Tumaini Joseph Nagu
- b Department of Internal Medicine , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania.,c Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Pamela Kaduri
- d Department of Psychiatry and Mental Health , Muhimbili National Hospital , Dar es Salaam , Tanzania
| | - Wafaie Fawzi
- e Departments of Global Health and Population, Nutrition and Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Ferdinand Mugusi
- b Department of Internal Medicine , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
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18
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de Vocht F, Brown J, Beard E, Angus C, Brennan A, Michie S, Campbell R, Hickman M. Temporal patterns of alcohol consumption and attempts to reduce alcohol intake in England. BMC Public Health 2016; 16:917. [PMID: 27585991 PMCID: PMC5009608 DOI: 10.1186/s12889-016-3542-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Alcohol Toolkit Study (ATS) is a monthly survey of approximately 1700 adults per month aged 16 years of age or more in England. We aimed to explore patterns of alcohol consumption and motivation to reduce alcohol use in England throughout the year. METHODS Data from 38,372 participants who answered questions about alcohol consumption (March 2014 to January 2016) were analysed using weighted regression using the R survey package. Questions assessed alcohol consumption (AUDIT-C) and attempts to reduce consumption. RESULTS Sixty-seven percent of participants reported using alcohol, with a small negative trend of about 2 % reduction over 12 months in the studied period (P < 0.01). These include ~25 % higher risk drinkers and ~10 % regular binge drinkers. About 20 % of higher risk drinkers indicated they were attempting to reduce their alcohol consumption. Attempts were lowest in December (-20 %; 95 % CI 0-35 %), but increases significantly in January (+41 %; 95 % CI 16-73 %) compared with other months (P < 0.001), indicating a small net gain; at least in attempts to reduce. However, there was no evidence that the increased motivation in January was accompanied by a reported decrease in consumption or binge drinking events. This could be an artefact of the use of AUDIT questions, but could also reflect a disconnect between attempting to reduce alcohol consumption and subsequent change; maybe as a result of lack of continuing support. CONCLUSIONS January is associated with moderate increased attempts to reduce alcohol consumption. However, we find little evidence of a change in alcohol consumption. In part, this may be due to temporal insensitivity of the AUDIT questions.
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Affiliation(s)
- Frank de Vocht
- NIHR School for Public Health Research, Bristol, United Kingdom. .,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Jamie Brown
- NIHR School for Public Health Research, Bristol, United Kingdom.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emma Beard
- NIHR School for Public Health Research, Bristol, United Kingdom.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Colin Angus
- NIHR School for Public Health Research, Bristol, United Kingdom.,ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- NIHR School for Public Health Research, Bristol, United Kingdom.,ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Michie
- NIHR School for Public Health Research, Bristol, United Kingdom.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rona Campbell
- NIHR School for Public Health Research, Bristol, United Kingdom.,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Matthew Hickman
- NIHR School for Public Health Research, Bristol, United Kingdom.,School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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19
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Vinikoor MJ, Mulenga L, Siyunda A, Musukuma K, Chilengi R, Moore CB, Chi BH, Davies MA, Egger M, Wandeler G. Association between hepatitis B co-infection and elevated liver stiffness among HIV-infected adults in Lusaka, Zambia. Trop Med Int Health 2016; 21:1435-1441. [PMID: 27499385 DOI: 10.1111/tmi.12764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe liver disease epidemiology among HIV-infected individuals in Zambia. METHODS We recruited HIV-infected adults (≥18 years) at antiretroviral therapy initiation at two facilities in Lusaka. Using vibration controlled transient elastography, we assessed liver stiffness, a surrogate for fibrosis/cirrhosis, and analysed liver stiffness measurements (LSM) according to established thresholds (>7.0 kPa for significant fibrosis and >11.0 kPa for cirrhosis). All participants underwent standardised screening for potential causes of liver disease including chronic hepatitis B (HBV) and C virus co-infection, herbal medicine, and alcohol use. We used multivariable logistic regression to identify factors associated with elevated liver stiffness. RESULTS Among 798 HIV-infected patients, 651 had a valid LSM (median age, 34 years; 53% female). HBV co-infection (12%) and alcohol use disorders (41%) were common and hepatitis C virus co-infection (<1%) was rare. According to LSM, 75 (12%) had significant fibrosis and 13 (2%) had cirrhosis. In multivariable analysis, HBV co-infection as well as male sex, increased age and WHO clinical stage 3 or 4 were independently associated with LSM >7.0 kPa (all P < 0.05). HBV co-infection was the only independent risk factor for LSM >11.0 kPa. Among HIV-HBV patients, those with elevated ALT and HBV viral load were more likely to have significant liver fibrosis than patients with normal markers of HBV activity. CONCLUSIONS HBV co-infection was the most important risk factor for liver fibrosis and cirrhosis and should be diagnosed early in HIV care to optimise treatment outcomes.
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Affiliation(s)
- Michael J Vinikoor
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. .,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. .,Department of Medicine, University of Zambia, Lusaka, Zambia.
| | - Lloyd Mulenga
- Department of Medicine, University of Zambia, Lusaka, Zambia.,University Teaching Hospital, Lusaka, Zambia
| | - Alice Siyunda
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kalo Musukuma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton Moore
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Infectious Diseases, University of Dakar, Dakar, Senegal
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20
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Kabwama SN, Ndyanabangi S, Mutungi G, Wesonga R, Bahendeka SK, Guwatudde D. Alcohol use among adults in Uganda: findings from the countrywide non-communicable diseases risk factor cross-sectional survey. Glob Health Action 2016; 9:31302. [PMID: 27491961 PMCID: PMC4974493 DOI: 10.3402/gha.v9.31302] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/10/2016] [Accepted: 07/10/2016] [Indexed: 01/14/2023] Open
Abstract
Background There are limited data on levels of alcohol use in most sub-Saharan African countries. Objective We analyzed data from Uganda's non-communicable diseases risk factor survey conducted in 2014, to identify alcohol use prevalence and associated factors. Design The survey used the World Health Organization STEPS tool to collect data, including the history of alcohol use. Alcohol users were categorized into low-, medium-, and high-end users. Participants were also classified as having an alcohol-use-related disorder if, over the past 12 months, they were unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session the night before. Weighted logistic regression analysis was used to identify factors associated with medium- to high-end alcohol use. Results Of the 3,956 participants, 1,062 (26.8%) were current alcohol users, including 314 (7.9%) low-end, 246 (6.2%) medium-end, and 502 (12.7%) high-end users. A total of 386 (9.8%) were classified as having an alcohol-use-related disorder. Male participants were more likely to be medium- to high-end alcohol users compared to females; adjusted odds ratio (AOR)=2.34 [95% confidence interval (CI)=1.88–2.91]. Compared to residents in eastern Uganda, participants in central and western Uganda were more likely to be medium- to high-end users; AOR=1.47 (95% CI=1.01–2.12) and AOR=1.89 (95% CI=1.31–2.72), respectively. Participants aged 30–49 years and those aged 50–69 years were more likely to be medium- to high-end alcohol users, compared to those aged 18–29 years, AOR=1.49 (95% CI=1.16–1.91) and AOR=2.08 (95% CI=1.52–2.84), respectively. Conclusions The level of alcohol use among adults in Uganda is high, and 9.8% of the adult population has an alcohol-use-related disorder.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | | | - Gerald Mutungi
- Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Ronald Wesonga
- School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - Silver K Bahendeka
- Department of Internal Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda;
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Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use. AIDS 2016; 30:1111-9. [PMID: 26760454 DOI: 10.1097/qad.0000000000001019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We evaluated whether heavy alcohol use, illicit drug use or high levels of anxiety, and depression symptoms were modifiers of the retention through enhanced personal contact intervention. The intervention had previously demonstrated overall efficacy in the parent study. DESIGN Randomized trial. METHODS A total of 1838 patients from six US HIV clinics were enrolled into a randomized trial in which intervention patients received an 'enhanced contact' protocol for 12 months. All participants completed an audio computer-assisted self-interview that measured depression and anxiety symptoms from the Brief Symptom Inventory, alcohol use from the Alcohol Use Disorders Identification Test-Consumption instrument, and drug use from the WHO (Alcohol, Smoking and Substance Involvement Screening Test) questions. The 12-month binary outcome was completing an HIV primary care visit in three consecutive 4-month intervals. The outcome was compared between intervention and standard of care patients within subgroups on the effect modifier variables using log-binomial regression models. RESULTS Persons with high levels of anxiety or depression symptoms and those reporting illicit drug use, or heavy alcohol consumption had no response to the intervention. Patients without these 'higher risk' characteristics responded significantly to the intervention. Further analysis revealed higher risk patients were less likely to have successfully received the telephone contact component of the intervention. Among higher risk patients who did successfully receive this component, the intervention effect was significant. CONCLUSION Our findings suggest that clinic-based retention-in-care interventions are able to have significant effects on HIV patients with common behavioral health issues, but the design of those interventions should assure successful delivery of intervention components to increase effectiveness.
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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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Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, Luitel NP, Nakku J, Lund C, Medhin G, Patel V, Petersen I, Shrivastava S, Tomlinson M. Maternal mental health in primary care in five low- and middle-income countries: a situational analysis. BMC Health Serv Res 2016; 16:53. [PMID: 26880075 PMCID: PMC4754802 DOI: 10.1186/s12913-016-1291-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/05/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. METHODS The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. RESULTS Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3-50 %) and alcohol consumption during pregnancy (5-51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. CONCLUSIONS It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
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Affiliation(s)
- Emily C. Baron
- />Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa
| | - Charlotte Hanlon
- />Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- />King’s College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK
| | - Sumaya Mall
- />Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa
| | - Simone Honikman
- />Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Erica Breuer
- />Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa
| | | | - Nagendra P. Luitel
- />Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Juliet Nakku
- />Butabika National Mental Hospital, Kampala, Uganda
| | - Crick Lund
- />Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa
- />King’s College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK
| | - Girmay Medhin
- />Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- />London School of Hygiene and Tropical Medicine, London, UK
- />Public Health Foundation of India, New Delhi, India
- />Sangath, Goa, India
| | | | | | - Mark Tomlinson
- />Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town, South Africa
- />Alan J Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Hahn JA, Emenyonu NI, Fatch R, Muyindike WR, Kekiibina A, Carrico AW, Woolf-King S, Shiboski S. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction 2016; 111:272-9. [PMID: 26381193 PMCID: PMC4715487 DOI: 10.1111/add.13173] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 07/20/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
AIMS We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone. DESIGN A prospective 1-year observational cohort study with quarterly visits. SETTING Large rural HIV clinic in Mbarara, Uganda. PARTICIPANTS A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption. MEASUREMENTS Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use. FINDINGS The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively. CONCLUSIONS Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
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Affiliation(s)
- Judith A Hahn
- University of California, Department of Medicine, San Francisco, CA, USA
- University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Nneka I Emenyonu
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Robin Fatch
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Winnie R Muyindike
- Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Allen Kekiibina
- Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Adam W Carrico
- University of California, Department of Community Health Systems, San Francisco, CA, USA
| | - Sarah Woolf-King
- University of California, Department of Medicine, San Francisco, CA, USA
| | - Stephen Shiboski
- University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
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High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:153. [PMID: 26805868 PMCID: PMC4772173 DOI: 10.3390/ijerph13020153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/30/2015] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.
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Abstract
Objectives Mental health conditions can erode quality of life and interfere with health-related behaviours such as medication adherence. We aimed to determine the prevalence and correlates of depression and other psychosocial factors among self-identified men who have sex with men (MSM) in coastal Kenya. Design A cross-sectional survey. Methods Psychosocial and mental health characteristics were assessed in an audio computer-assisted self-interview (ACASI) survey among 112 MSM participating in two ongoing HIV-positive and HIV-negative cohorts in Mtwapa, Kenya. Results One-third of participants met criteria for major depressive disorder [16.1%, 95% confidence interval (95% CI) 9.8–24.2] or other depressive disorder (15.2%, 95% CI 9.1–23.2). Alcohol abuse was reported by 45% of respondents (95% CI 35.2–54.3) and other substance abuse by 59.8% (95% CI 50.1–69.0). Sexual and HIV stigma were moderate, with median scores of 11 [interquartile range (IQR) 6–17, potential range 0–33] and 25 (IQR 23–29, potential range 11–44), respectively. There were significant bivariate correlations between alcohol abuse, other substance abuse, sexual stigma and childhood and recent abuse. In a multivariable linear regression model, sexual stigma (beta = 0.17, 95% CI 0.03–0.32) and marriage to a woman (beta = −2.41 95% CI −4.74 to −0.09) were each associated with depression score. Conclusion We found moderate to high levels of depression and substance abuse, and moderate levels of sexual stigma. These variables were highly inter-correlated and associated with an experience of trauma or abuse. Comprehensive mental health services are needed in this population to address these issues.
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Sundararajan R, Wyatt MA, Woolf-King S, Pisarski EE, Emenyonu N, Muyindike WR, Hahn JA, Ware NC. Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda. AIDS Behav 2015; 19:732-41. [PMID: 25323678 PMCID: PMC4392168 DOI: 10.1007/s10461-014-0918-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alcohol has a substantial negative impact on the HIV epidemic in sub-Saharan Africa, particularly in Uganda, where heavy alcohol consumption is common. Using a content analytic approach, this qualitative study characterizes changes in alcohol use among 59 HIV-infected Ugandan adults (>18 years old), who reported any alcohol use in the previous year as they entered HIV care. Most participants reported attempting to cease or reduce alcohol intake over the study period. Reasons for decreased use included advice from clinicians, interference with social obligations, threats to financial security, and negative impact on social standing. Participants reported difficulty abstaining from alcohol, with incentives to continue drinking including desire for social inclusion, stress relief, and enjoyment of alcohol. These contrasting incentives created a moral quandary for some participants, who felt 'pulled' between 'good' and 'bad' influences. Results suggest brief interventions addressing self-identified obstacles to change may facilitate long-term reductions in drinking in this population.
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Kalema D, Vindevogel S, Baguma PK, Derluyn I, Vanderplasschen W. Alcohol misuse, policy and treatment responses in Sub-Saharan Africa: The case of Uganda. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1006180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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