Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Velloza, Jennifer; Kemp, Christopher G.; Aunon, Frances M.; Ramaiya, Megan; Creegan, Emma; Simoni, Jane M.

doi:10.1007/s10461-019-02716-0

Cited by 86 publications

(75 citation statements)

References 90 publications

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“…Our findings are consistent with other studies in Africa, [67][68][69] that further show that the risk perception of HIV infection was low among some men as they did not view themselves to be at risk even when engaging in high risk behaviors or altogether lacked self-awareness of risk due excessive consumption of alcohol. In their study, Velloza et al [70] found that individuals who used alcohol had twice the odds of ART non-adherence compared with those who did not use alcohol (34% non-adherence among alcohol users vs. 18% among non-users; pooled odds ratio: 2.25; 95% confidence interval: 1.87-2.69; p < 0.001). While prevalence of alcohol misuse based on AUDIT/CAGE in SSA is estimated at 32.8% (IQR 20.8-48.5%) [71] and 31.7% (95% confidence interval (CI): 26.8%-37.2%).…”

Section: Discussionmentioning

confidence: 95%

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

et al. 2020

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HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of �500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, healthcare system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/ inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.

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Section: Discussionmentioning

confidence: 95%

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

et al. 2020

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“…The effect of alcohol use on self-reported ART adherence in this study is consistent with previous research in other populations. A recent systematic review and meta-analysis of studies in sub-Saharan Africa, including male and female populations, found a consistent association between alcohol use and varied measures of lower ART adherence or ART non-use, with a pooled effect estimate of 2.25 (95%CI 1.87–2.69) [ 2 ]. The review identified only one study conducted among FSWs [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Viral suppression requires adherence to daily antiretroviral therapy (ART), which can be difficult due to multiple psychosocial and structural barriers such as fear of disclosure of HIV status, stigma, and difficulty in following a daily regimen [1]. Studies in high-and low-income countries have demonstrated that alcohol use is associated with poor ART adherence [1][2][3][4]. Fewer studies have examined the association between alcohol use and viral suppression, particularly in low-income settings, and these provide conflicting results [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

et al. 2020

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Background Excessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs. Methods A prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Results This analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7–15) in 14.3%, harmful alcohol use (AUDIT 16–19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63–1.92) or late ART refill (aRR 1.13, 95%CI 0.82–1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42–3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84–3.71). Conclusions In this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.

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“…Although many interventions have been developed to address drinking 19,20 and ART adherence 14,[16][17][18] among PLWH, many require substantial provider time or show limited efficacy. Given the well-documented relationship between heavy drinking and poor ART adherence [5][6][7][8] , our intervention addresses these two concerns together among alcohol dependent PLWH. The current intervention utilizes smartphone technology to provide an extended intervention without taxing providers' time, thus providing a feasible intervention method in HIV primary care.…”

Section: Discussionmentioning

confidence: 99%

“…Among PLWH, heavy drinking has been shown to hasten disease progression 3 , interfere with the full spectrum of engagement in HIV care 4,5 , and in particular, to interfere with HIV medication adherence [5][6][7][8] . Further, beyond unintentional nonadherence, some patients engage in intentional non-adherence due to fears of harmful effects from combining alcohol with ART [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

HealthCall: Smartphone Enhancement of Brief Interventions to Improve Medication Adherence Among Patients in HIV care

Hasin

Aharonovich

Zingman

et al. 2020

Preprint

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BackgroundHeavy drinking among People Living With HIV (PLWH) reduces antiretroviral adherence and worsens health outcomes. Lengthy interventions to reduce drinking and improve adherence are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed and tested HealthCall as an electronic (smartphone) means of increasing patient involvement in brief intervention to reduce drinking and improve medication adherence without making unfeasible demands on providers.MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinician’s Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline interventions targeting drinking reduction and medication adherence were ∼25 minutes, with brief (10-15 min) booster sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking, medication adherence, and other aspects of the prior 24 hours. Our outcome, assessed at 30 and 60 days, and 3, 6 and 12 months, was ART adherence (using unannounced phone pill-count method; possible adherence scores: 0%-100%). Analysis: generalized linear mixed models with pre-planned contrasts.ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. ART adherence was generally high throughout follow-up, with some decline by 12 months. Although both CG+HealthCall and MI+HealthCall evidenced benefits early in follow-up, by 6 months, ART adherence was 11% better among patients in CG+HealthCall than in CG-only (p=0.03) and 9% better than among patients in MI+HealthCall (p=0.07). Efficacy differed slightly by gender (p=.09).ConclusionHealthCall paired with CG resulted in better ART adherence than CG alone. MI+HealthCall’s early benefits diminished over time. Given the importance of ART adherence and drinking reduction among PLWH, and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

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Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Cited by 86 publications

References 90 publications

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

HealthCall: Smartphone Enhancement of Brief Interventions to Improve Medication Adherence Among Patients in HIV care

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