Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study

Abstract

BackgroundDepression and alcohol use disorder have been shown to be associated with poor adherence to antiretroviral therapy (ART). Studies examining their association with viral suppression in rural Africa are, however, scarce.MethodsThis study reports prevalence of depressive symptoms and alcohol use disorder, and their potential association with adherence and viral suppression in adult patients on ART in ten clinics in rural Lesotho, Southern Africa.ResultsAmong 1,388 adult patients (69 % women), 80.7 % were alcohol abstinent, 6.3 % were hazardous drinkers (men: 10.7 %, women: 4.4 %, p < 0.001). The prevalence of depressive symptoms was 28.8 % (men 20.2 %, women 32.7 %, p < 0.001). Both alcohol consumption (adjusted odds-ratio: 2.09, 95 % CI: 1.58-2.77) and alcohol use disorder (2.73, 95 % CI: 1.68-4.42) were significantly associated with poor adherence. There was, however, no significant association with viral suppression.ConclusionsWhereas the results of this study confirm previously reported association of alcohol use disorder with adherence to ART, there was no association with viral suppression.Trial registrationApril 28th 2014; NCT02126696.

The prevalence and factors associated with alcohol use disorder among people living with HIV/AIDS in Africa: a systematic review and meta-analysis

“…Representativeness and size of the sample, comparability between study subjects, ascertainment of alcohol use disorder symptoms, and statistical quality were the dimensions of NOS in assessing the quality of each study. The quality of cross-sectional studies included [ 8 – 10 , 12 – 16 , 18 – 20 , 23 , 27 , 28 , 49 , 51 , 52 , 55 ] was also evaluated using the Johanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies [ 56 ].…”

“…Based on the type of study design, 18 studies were cross-sectional type [8-10, 12-16, 18-20, 23, 27, 28, 49, 51, 52, 55] and the other four studies [11,17,21,22] were cohort in design. Among the 22 studies in the meta-analysis [7-23, 27, 28, 49-52], 5 were from Ethiopia [7,27,28,49,51], 3 from Nigeria [8][9][10], 4 from Uganda [11][12][13][14], 4 form south Africa [15][16][17][18] and the remaining 6 studies were from Kenya, Namibia, and Zambia [19][20][21][22][23]52].…”

“…Considering year of publication, the average prevalence of AUD in studies published before 2011 [9,12,15], 2011-2015 [10,13,14,19,[21][22][23]51], and after 2015 [7,8,11,17,18,20,27,28,49,50,52] Table 1 Characteristics of studies on the 1 year prevalence alcohol use disorders among HIV/AIDS patients on ART which are incorporated in the narrative as well as meta-analysis according to author first name, year of publication, setting of study, design, sample size, assessment instrument, study population and magnitude of alcohol use disorder (Fig. 3) and ( Table 2).…”

“…6). The average prevalence of dependent drinking among studies that utilized a sample of more than 400 [8,18,22,27,51] [19,49].…”

“…A systematic review and meta-analysis study by Duko et al 2019 [7] showed that the average worldwide prevalence of AUD among patients with HIV/AIDS was found to be 29.8%. Other earlier studies in Africa reported that the prevalence of AUD ranges from 17 to 39.4% in Nigeria [8][9][10], 1.4 to 33% in Uganda [11][12][13][14], 6.6 to 48.5% in South Africa [15][16][17][18], 5.4 to 33% in Kenya [19][20][21][22], and 14.8% in Zambia [23]. There exists a scarcity of average data on alcohol use disorders in people with HIV in other African countries despite the high disease burden with people living with HIV (PLWHA) [24].…”