High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda

Abstract

Background: Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. Methods: Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). Results: Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23–29], median gestational age was 20 weeks [interquartile range: 16–26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). Conclusions: Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.

Alcohol use during pregnancy in Rakai, Uganda

“…Next, alcohol use, number of sex partners, and IPV were self-reported and participants might have underestimated or forgotten their true behaviors, potentially leading to reduced accuracy of findings. However, it is encouraging to note that our alcohol use findings are similar to previous studies, some of which used biomarkers [ 7 ]. Third, our analysis is among women who self-reported as pregnant and our sample included some women who were not pregnant and excluded women who were unknowingly pregnant.…”

“…We found that the prevalence of self-reported drinking during pregnancy in Rakai, Uganda, was over three times higher than the global average of alcohol use among pregnant women [ 3 ], higher than previous studies conducted among pregnant women in other regions of Uganda [ 6 , 7 ], but lower than the prevalence of alcohol use among non-pregnant women in Rakai, Uganda [ 8 ]. Correlates of alcohol use during pregnancy were Catholic religion, occupation in a restaurant or bar, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and experiencing IPV.…”

“…A 2010 study found that among a sample of pregnant women seeking antenatal care at the national referral hospital in Kampala (Uganda’s capital city), 25% reported alcohol use after learning they were pregnant [ 6 ]. Another study that combined self-reported alcohol use and a blood biomarker found that 20% of pregnant women living with HIV in southwestern Uganda met the criteria for hazardous alcohol use [ 7 ].…”

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

“…In Mpumalanga Province, South Africa, self-reported adherence to ART was 69% among pregnant WLWH [11] and in Zimbabwe, only 40% of women were taking at least 95% of ART by pill count one year postpartum [12]. Qualitative data from sub-Saharan African sites suggest that adherence challenges for pregnant and postpartum WLWH relate to structural barriers to care, community and healthcare stigma, medication side effects, depression, substance use and the overwhelming challenges of poverty, gender norms, and life with a newborn [13][14][15][16][17][18][19][20].…”

Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women

“…The WHO does not provide detailed advice on how to screen pregnant women, but screening methods based on questionnaires are mentioned as an alternative. However, self‐reporting has been shown to underestimate alcohol use and to be unreliable among pregnant women due to poor memory, social stigma, and fear of child welfare interventions (Ferraguti et al, 2017; Lange et al, 2017; Raggio et al, 2019).…”