Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

Abstract

Background In sub-Saharan Africa (SSA), HIV-infected patients may under-report alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel non-volume measures, and the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). Methods We analyzed cohort-entry data from the Biomarker Research of Ethanol in Those with HIV cohort study (2011-2013). Participants were HIV-infected past year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman’s rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CI) for pairwise differences between coefficients. Results A total of 209 subjects (57% male) were included. Median age was 30; inter-quartile range (IQR) 25-38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2137) were higher than QF grams (375, IQR 33 to 1776), p<0.001. However, both measures were moderately correlated with PEth; rho = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference −0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (rho = 0.35 to 0.57). Conclusion HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed, suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other non-volume measures may provide simpler alternatives.

Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda

“…In our previous study in this setting, we found only moderate correlation between self-reported measures of drinking and PEth [22]. …”

“…Both studies were prospective observational cohorts of HIV-infected adults at the Immune Suppression Syndrome (ISS) clinic in Mbarara, Uganda. ADEPT’s aim was to determine the effect of alcohol consumption on pre-ART HIV disease progression; BREATH aimed to describe changes in alcohol consumption during the first year of HIV care [22, 27, 28]. Eligibility criteria for both cohorts included: HIV-infected adult (age ≥ 18), enrolled into care at the ISS clinic and not yet on ART, fluent in English or Runyankole (the local language), living within 60km of the clinic, and for BREATH only, new to the ISS Clinic and HIV care, and reporting past-year alcohol use.…”

“…Participants were asked to report volumes consumed for each alcohol type on a “typical drinking day” in the past 3 months and their frequency of drinking in the past 3 months. These two quantities were used to calculate the total (beverage-specific) alcohol volumes consumed in the past 3 months as previously described [22]. …”

“…Participants reported the date of first HIV-positive diagnosis; from this, we calculated the years since diagnosis, at enrollment. As underreporting of alcohol use is common in HIV-infected patients in Uganda, we measured levels of the alcohol biomarker phosphatidylethanol (PEth) as previously described [22], and controlled for this variable in a sensitivity analysis. In both countries, we also measured participants’ CD4+ T-cell count levels (APC-H7, BD Biosciences, for the Russia sample, and Beckman Coulter, Brea, California, for the Uganda sample).…”

“…These associations were adjusted for total volume of alcohol consumed, but not drinking patterns. We are not aware of any studies reporting on the association of “locally-made” alcohols with health outcomes; these “locally-made” alcohols are commonly consumed in Uganda [22]. …”