Hazardous and Harmful use of Alcohol and/or Other Drugs and Health Status Among South African Patients Attending HIV Clinics

Abstract

There is growing recognition of the influence of substance use, particularly alcohol use, on HIV disease progression. This study investigated how hazardous/harmful use of alcohol and drugs impacts the health status of 1503 patients attending HIV clinics. Of the sample, 37 % indicated hazardous/harmful drinking and 13 % indicated a drug problem. Hazardous/harmful use of alcohol and drugs was significantly related to health status, with participants using substances more likely to have TB-positive status (χ(2) = 4.30, p < 0.05), less likely to be on ARVs (χ(2) = 9.87, p < 0.05) and having lower CD4 counts (t = 4.01, p < 0.05). Structural equation modelling confirmed the centrality of hazardous/harmful use of alcohol as a direct and indirect determinant of disease progression. Based on these findings it is recommended that patients attending HIV clinics be routinely screened for problematic alcohol and/or drug use, with strong emphasis on ensuring ARV adherence in those with problematic alcohol use.

Heavy alcohol use in patients on highly active antiretroviral therapy: What responses are needed?

“…Although the sample size was relatively small and excluded individuals who refused screening or reported no drinking in the past year, the findings broadly align with those of Kader et al, [5] who found that 91% of male and 89% of female drinkers (most of whom were receiving ART) attending eight HIV clinics in Cape Town reported hazardous or harmful alcohol consumption when screened with the AUDIT. A similar study conducted in Tshwane in two HIV clinics among patients on ART found slightly lower corresponding figures of 75% for male and 55% for female drinkers, but like the findings of Kader et al, [5] these are somewhat higher than ours reported above.…”

“…A similar study conducted in Tshwane in two HIV clinics among patients on ART found slightly lower corresponding figures of 75% for male and 55% for female drinkers, but like the findings of Kader et al, [5] these are somewhat higher than ours reported above. The high proportions of men and women who drink heavily is of grave concern given the associated risk for reduced ART adherence, [6] forward transmission of HIV, and other health problems.…”

“…The high proportions of men and women who drink heavily is of grave concern given the associated risk for reduced ART adherence, [6] forward transmission of HIV, and other health problems. [7] Given the high levels of problematic drinking that were evident among patients on ART in Tshwane, we agree with recommendations made previously [2,5] that there should be more screening of patients attending HIV clinics for problematic alcohol use as a prelude to implementing brief interventions to reduce the negative impact of drinking on HIV treatment outcome, or where necessary referring HIV patients to more intensive treatment. However, the 2 -4 minutes typically taken to administer and score the AUDIT [4] is likely to serve as a barrier to its routine use in primary care settings, and as a result further research is also needed to assess the possibility of using briefer screening instruments in primary care settings.…”

Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho

“…The high prevalence of symptomatology we found, coupled with the extensive evidence about poor treatment outcomes among TB and HIV patients with mental health conditions, 7–11 suggest there is a need to increase and improve screening and treatment for depressive symptoms and hazardous/harmful alcohol use in Lesotho. Although our study is among the first to quantitatively assess these conditions among TB-HIV patients, and to investigate TB- and HIV-related stigma, the data were collected for another primary aim.…”

“…We found a high prevalence of both, a result that is consistent with the limited literature on mental health among individuals with HIV and TB in sub-Saharan Africa. 11,25–27 Depressive symptoms and hazardous/harmful alcohol use appeared to primarily affect distinct groups. Due to the small sample size, we did not formally explore correlates, but individuals who reported both were predominantly men who endorsed higher external stigma about HIV.…”