Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus

Abstract

BackgroundThe primary objectives of this study were to determine the association between alcohol and antiretroviral therapy (ART) adherence and the perceived appropriateness and acceptability of elements of an adherence counseling program with a focus on alcohol-related ART nonadherence among a sample of ART recipients in human immunodeficiency virus (HIV) clinics in Tshwane, South Africa.MethodsWe conducted a cross-sectional study with purposive sampling. The sample comprised 304 male and female ART recipients at two President’s Emergency Plan For AIDS Relief-supported HIV clinics. Using an interview schedule, we assessed patients’ alcohol use (Alcohol Use Disorders Identification Test), other drug use, level of adherence to ART, and reasons for missing ART doses (AIDS Clinical Trials Group adherence instrument). Additionally, patients’ views were solicited on: the likely effectiveness of potential facilitators; the preferred quantity, duration, format, and setting of the sessions; the usefulness of having family members/friends attend sessions along with the patient; and potential skill sets to be imparted.ResultsAbout half of the male drinkers’ and three quarters of the female drinkers’ Alcohol Use Disorders Identification Test scores were suggestive of hazardous or harmful drinking. Average self-reported ART adherence was 89.7%. There was a significant association between level of alcohol use and degree of ART adherence. Overall, participants perceived two clinic-based sessions, each of one hour’s duration, in a group format, and facilitated by a peer or adherence counselor, as most appropriate and acceptable. Participants also had a favorable attitude towards family and friends accompanying them to the sessions. They also favored an alcohol-focused adherence counseling program that employs motivational interviewing and cognitive behavioral therapy-type approaches.ConclusionThe association between alcohol use and ART nonadherence points to a need for alcohol-focused ART adherence interventions. Patients’ perceptions suggest their amenability to clinic-based brief motivational interviewing and cognitive behavioral therapy-type adherence interventions delivered by lay persons in group settings. Further research should investigate how best to implement such interventions in the existing health system.

Efeito do álcool em pessoas com HIV: tratamento e qualidade de vida

“…(3,4) Many PLWHA use alcohol because it acts on their mental state, providing relief of stress from the stigma and prejudice. (5) It is also noted that abusive use of this substance, and of other drugs, negatively influences Quality of Life (QoL). (6) QoL can be described as a subjective expression, covering several areas, including social, environmental, and spiritual relations, varying from individual to individual, and this depends on health status, because it is a result of the interaction of different areas of human life.…”

“…(6) QoL can be described as a subjective expression, covering several areas, including social, environmental, and spiritual relations, varying from individual to individual, and this depends on health status, because it is a result of the interaction of different areas of human life. (4,7) Therefore, considering the increase in alcohol consumption among PLWHA, (3)(4)(5) and consequently its possible repercussions on ART adherence and quality of life, this study was designed to evaluate the effect of alcohol on adherence to antiretroviral therapy and quality of life of HIV-infected individuals.…”

The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: Event-level findings from a daily diary study

“…Global associations can tell us if those who drink, or tend to drink at higher risk levels, are more likely to have poorer adherence in general. There is evidence of a global association between alcohol consumption and poor ARV adherence in South Africa and other sub-Saharan countries (e.g., Kip et al, 2009; Kekwaletswe and Morojele, 2014; Morojele et al, 2014). However, such studies fail to establish if on days when individuals drink alcohol they more likely to miss taking their ARVs compared to days when they do not drink alcohol.…”

Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis

“…Second, due to the limited information regarding the effects of various levels of adherence, we have dichotomized the treatment effect of our modeled CBT as “abstinent” vs. “non-abstinent. It is possible that if continuous data were available regarding the effect of reducing drinking by one drink, then our modeled CBT would be shown to have even greater levels of benefits in terms of ARV adherence and reduced HIV infectivity given the positively correlation between alcohol use and these modeled benefits [7, 31, 36, 37, 64–67, 71–73]. Third, cost-benefit models regarding future cost-savings carry inherent uncertainty as assumptions must be made regarding the consequences of an intervention.…”

“…CBT—in reducing alcohol consumption—has been identified as a method to increased ARV adherence [71–73]. ARV adherence and its resulting medical and functional benefits, in turn, have been shown to increase labor force participation (LFP) [74–77] and increase household productivity (HP) [78].…”