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Kulkarni S, Weber SE, Buys C, Lambrechts T, Myers B, Drainoni ML, Jacobson KR, Theron D, Carney T. Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa. RESEARCH SQUARE 2023:rs.3.rs-3290185. [PMID: 37841852 PMCID: PMC10571641 DOI: 10.21203/rs.3.rs-3290185/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment. Methods Focus groups (FGs) were conducted with 34 participants who had previous or current drugsusceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa. Results In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FG participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints while FG participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FG participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use as well and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services. Conclusion Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.
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Myers B, Carney T, Rooney J, Malatesta S, Ragan EJ, White LF, Natcheva H, Bouton TC, Weber SE, Farhat M, McIlleron H, Theron D, Parry CDH, Horsburgh CR, Warren RM, Jacobson KR. Smoked drug use in patients with TB is associated with higher bacterial burden. Int J Tuberc Lung Dis 2023; 27:444-450. [PMID: 37231597 PMCID: PMC10407961 DOI: 10.5588/ijtld.22.0650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.
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Affiliation(s)
- B Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - T Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - E J Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - L F White
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - H Natcheva
- Department of Radiology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - T C Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S E Weber
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - M Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - D Theron
- Western Cape Department of Health, Pretoria, South Africa
| | - C D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - R M Warren
- Department of Science and Technology, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Estimating the changing burden of disease attributable to alcohol use in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:662-675. [DOI: 10.7196/samj.2022.v112i8b.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background. Alcohol use was one of the leading contributors to South Africa (SA)’s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first South African Comparative Risk Assessment Study (SACRA1). Since then, patterns of alcohol use have changed, as has the epidemiological evidence pertaining to the role of alcohol as a risk factor for infectious diseases, most notably HIV/AIDS and tuberculosis (TB).Objectives. To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012.Methods. The analysis follows the World Health Organization (WHO)’s comparative risk assessment methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies. PAFs were applied to the burden of disease estimates from the revised second South African National Burden of Disease Study (SANBD2) to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (≥15 years old) in a Bayesian model. We assumed no uncertainty in the outcome measures.Results. The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI) 6.6 - 7.6) of all deaths and 5.6% (95% UI 5.3 - 6.0) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Alcohol remains an important contributor to the overall disease burden, ranking fifth in terms of deaths and DALYs.Conclusion. Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by the WHO’s SAFER initiative.
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Wechsberg WM, van der Drift I, Howard BN, Myers B, Browne FA, Bonner CP, Carney T, Ndirangu J, Washio Y. Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8661. [PMID: 35886515 PMCID: PMC9316816 DOI: 10.3390/ijerph19148661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.
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Affiliation(s)
- Wendee M. Wechsberg
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708, USA
| | - Isa van der Drift
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Brittni N. Howard
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
| | - Felicia A. Browne
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tara Carney
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jacqueline Ndirangu
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Yukiko Washio
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19122, USA
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Khan U, Lotia-Farrukh I, Akhtar A, Khowaja SN, Khan S, Madhani F, Parekh A, Adnan S, Ahmed S, Chaudhry M, Hussain H, Habib A, Butt S, Siddiqui MR, Ijaz R, Jamal S, Khan AB, Keshavjee S, Khan AJ, Salahuddin N, Khan PY. Re-Evaluating the Merits of Decentralisation as a Core Strategy for Effective Delivery of Drug-Resistant Tuberculosis Care in Pakistan. Health Policy Plan 2022; 37:979-989. [PMID: 35527232 PMCID: PMC9384034 DOI: 10.1093/heapol/czac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/04/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models—made increasingly urgent by the COVID-19 pandemic—are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005–1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
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Affiliation(s)
- Uzma Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Ahwaz Akhtar
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saira N Khowaja
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | | | - Asra Parekh
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Sana Adnan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Mariam Chaudhry
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Hamidah Hussain
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Ali Habib
- Interactive Health Solutions, Karachi, Sindh, Pakistan
| | - Shahid Butt
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Muhammad R Siddiqui
- Provincial TB Program, Sindh, Pakistan
- Institute of Chest Diseases, Kotri, Sindh, Pakistan
| | - Raafia Ijaz
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saba Jamal
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Abdul B Khan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Salmaan Keshavjee
- Harvard University, Cambridge, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Aamir J Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Palwasha Y Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Reuter A, Beko B, Memani B, Furin J, Daniels J, Rodriguez E, Reuter H, Weich L, Isaakidis P, von der Heyden E, Kock Y, Mohr-Holland E. Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa. Trop Med Infect Dis 2022; 7:tropicalmed7020021. [PMID: 35202216 PMCID: PMC8879094 DOI: 10.3390/tropicalmed7020021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Substance use (SU) is associated with poor rifampicin-resistant tuberculosis (RR-TB) treatment outcomes. In 2017, a SBIRT (SU screening-brief intervention-referral to treatment) was integrated into routine RR-TB care in Khayelitsha, South Africa. This was a retrospective study of persons with RR-TB who were screened for SU between 1 July 2018 and 30 September 2020 using the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Here we describe outcomes from this program. Persons scoring moderate/high risk received a brief intervention and referral to treatment. Overall, 333 persons were initiated on RR-TB treatment; 38% (n = 128) were screened for SU. Of those, 88% (n = 113/128) reported SU; 65% (n = 83/128) had moderate/high risk SU. Eighty percent (n = 103/128) reported alcohol use, of whom 52% (n = 54/103) reported moderate/high risk alcohol use. Seventy-seven persons were screened for SU within ≤2 months of RR-TB treatment initiation, of whom 69%, 12%, and 12% had outcomes of treatment success, loss to follow-up and death, respectively. Outcomes did not differ between persons with no/low risk and moderate/high risk SU or based on the receipt of naltrexone (p > 0.05). SU was common among persons with RR-TB; there is a need for interventions to address this co-morbidity as part of “person-centered care”. Integrated, holistic care is needed at the community level to address unique challenges of persons with RR-TB and SU.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
- Correspondence:
| | - Buci Beko
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Boniwe Memani
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Johnny Daniels
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Erickmar Rodriguez
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Hermann Reuter
- Faculty of Health Sciences, University of Cape Town, Cape Town 7701, South Africa;
| | - Lize Weich
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7701, South Africa;
| | - Petros Isaakidis
- Médecins Sans Frontières Southern Africa Medical Unit, Cape Town 7925, South Africa;
| | | | - Yulene Kock
- National Department of Health Tuberculosis Program, Pretoria 0187, South Africa;
| | - Erika Mohr-Holland
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
- Médecins Sans Frontières Southern Africa Medical Unit, Cape Town 7925, South Africa;
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Spedding M, Kohrt B, Myers B, Stein DJ, Petersen I, Lund C, Sorsdahl K. ENhancing Assessment of Common Therapeutic factors (ENACT) tool: adaptation and psychometric properties in South Africa. Glob Ment Health (Camb) 2022; 9:375-383. [PMID: 36618718 PMCID: PMC9806986 DOI: 10.1017/gmh.2022.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023] Open
Abstract
Background The ENhancing Assessment of Common Therapeutic factors (ENACT) tool measures a set of therapeutic competencies required for the effective psychological intervention, including delivery by non-specialists. This paper describes the systematic adaptation of the ENACT for the South African (SA) context and presents the tool's initial psychometric properties. Methods We employed a four-step process: (1) Item generation: 204 therapeutic factors were generated by SA psychologists and drawn from the original ENACT as potential items; (2) Item relevance: SA therapists identified 96 items that were thematically coded according to their relationship to one another and were assigned to six domains; (3) Item utility: The ENACT-SA scale was piloted by rating recordings of psychological therapy sessions and stakeholder input; and (4) Psychometric properties: Internal consistency and inter-rater reliability of the final 12-item ENACT-SA were explored using Cronbach's alpha and intraclass correlation co-efficient (ICC) for both clinical psychologists and registered counsellors. Results Although the original ENACT provided a framework for developing a tool for use in SA, several modifications were made to improve the applicability of the tool for the SA context, and optimise its adaptability other contexts. The adapted 12-item tool's internal consistency was good, while the inter-rater reliability was acceptable for both clinical psychologists and registered counsellors. Conclusion The ENACT-SA is a reliable tool to assess common factors in psychological treatments. It is recommended that the tool be used in conjunction with assessment protocols and treatment-specific competency measures to fully assess implementation fidelity and potential mechanisms of therapeutic change.
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Affiliation(s)
- Maxine Spedding
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Brandon Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Center for Rural Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Author for correspondence: Katherine Sorsdahl, E-mail:
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Morojele NK, Shenoi SV, Shuper PA, Braithwaite RS, Rehm J. Alcohol Use and the Risk of Communicable Diseases. Nutrients 2021; 13:3317. [PMID: 34684318 PMCID: PMC8540096 DOI: 10.3390/nu13103317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/12/2023] Open
Abstract
The body of knowledge on alcohol use and communicable diseases has been growing in recent years. Using a narrative review approach, this paper discusses alcohol's role in the acquisition of and treatment outcomes from four different communicable diseases: these include three conditions included in comparative risk assessments to date-Human Immunodeficiency Virus (HIV)/AIDS, tuberculosis (TB), and lower respiratory infections/pneumonia-as well as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) because of its recent and rapid ascension as a global health concern. Alcohol-attributable TB, HIV, and pneumonia combined were responsible for approximately 360,000 deaths and 13 million disability-adjusted life years lost (DALYs) in 2016, with alcohol-attributable TB deaths and DALYs predominating. There is strong evidence that alcohol is associated with increased incidence of and poorer treatment outcomes from HIV, TB, and pneumonia, via both behavioral and biological mechanisms. Preliminary studies suggest that heavy drinkers and those with alcohol use disorders are at increased risk of COVID-19 infection and severe illness. Aside from HIV research, limited research exists that can guide interventions for addressing alcohol-attributable TB and pneumonia or COVID-19. Implementation of effective individual-level interventions and alcohol control policies as a means of reducing the burden of communicable diseases is recommended.
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Affiliation(s)
- Neo K. Morojele
- Department of Psychology, University of Johannesburg, Johannesburg 2006, South Africa
| | - Sheela V. Shenoi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA;
- Yale Institute for Global Health, Yale University, New Haven, CT 06520, USA
| | - Paul A. Shuper
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
| | - Ronald Scott Braithwaite
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10013, USA;
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, 08005 Barcelona, Spain
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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