Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities

Lancaster, Kathryn E.; Hetrick, Angela; Jaquet, Antoine; Adedimeji, Adebola; Atwoli, Lukoye; Colby, Donn J.; Mayor, Angel M.; Parcesepe, Angela M.; Syvertsen, Jennifer L.

doi:10.1016/s2055-6640(20)30342-3

Cited by 29 publications

(14 citation statements)

References 97 publications

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“…The latter variable is unsurprising given the demonstrated association between substance use and medication non-adherence, and the explanation that substance use can serve as a coping mechanism for dealing with a chronic illness [62]. The risk factor of a positive HIV status for binge drinking is notable because heavy drinking can lead to high-risk sexual behaviours, increased potential for HIV transmission, sub-optimal ART adherence, and other health complications including liver disease [63].…”

Section: Plos Onementioning

confidence: 99%

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

et al. 2022

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Introduction Sex workers in South Africa experience high levels of trauma and mental health issues, but little is known about their drug and alcohol use. This study assessed the prevalence of substance use and its key risk factors amongst female sex workers (FSWs) at two sites in South Africa. Methods Two cross-sectional studies were conducted, in Soweto and Klerksdorp, South Africa. Using respondent-driven sampling (RDS) 508 FSWs in Soweto and 156 in Klerksdorp were enrolled. A study-specific survey was used to collect social and demographic information, substance use, mental ill-health, and HIV status. Raw and RDS-adjusted data were analyzed using Chi-squared tests of association. Weighted and unweighted Poisson regression models were used to assess key risk factors for alcohol and drug use at both univariate and multivariate levels. Results Of the 664 FSWs, 56.2% were binge drinkers and 29.4% reported using drugs within the last year. Living in a home with regular food (RR: 1.2597, 95% CI: 1.1009–1.4413) and being HIV positive (RR: 1.1678, 95% CI: 1.0227–1.3334) were associated with a higher risk of binge drinking. Having symptoms suggestive of post-traumatic stress disorder (RR: 1.1803, 95% CI: 1.0025–1.3895) and past year physical/sexual abuse from either intimate (RR: 1.3648, 95% CI: 1.1522–1.6167) or non-intimate partners (RR: 1.3910, 95% CI: 1.1793–1.6407) were associated with a higher risk of drug use. Discussion In conclusion, our findings demonstrate a high prevalence of alcohol and drug use among FSWs in Soweto and Klerksdorp with site-specific contextual dynamics driving substance use. Site differences highlight the importance of tailoring site-specific substance use harm mitigation for this key population.

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Section: Plos Onementioning

confidence: 99%

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

et al. 2022

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“…At the end of 2018, IeDEA published a consensus statement 61 and a journal supplement 62 on research priorities to inform the implementation of the 'Treat All' policy in children and adolescents, 63 pregnant and postpartum women, 64 and for mental health, substance use 65 and drug resistance. 66 These documents will guide IeDEA's future research agenda in sub-Saharan Africa.…”

Section: Future Plansmentioning

confidence: 99%

International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012–2019

et al. 2020

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PurposeThe objectives of the International epidemiology databases to evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and coinfections and (iv) to examine the pregnancy-related and HIV-related outcomes of women on ART and their infants exposed to HIV or ART in utero or via breast milk.ParticipantsIeDEA is organised in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in PLWHIV-1 or PLWHIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of coinfection with hepatitis B and C, and the epidemiology of different cancers and of (multidrug resistant) tuberculosis, renal disease and of mental illness. The adoption of ‘Treat All’, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the ‘Treat All’ era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

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“…In most resource-constrained HIV care settings, providers rarely screen nor treat patients for alcohol and substance use or mental health disorders (15). There is a critical need for research to identify effective and efficient strategies to integrate alcohol and substance use screening and brief interventions into HIV care delivery programs in LMICs (15,16). Despite possibilities for impact, alcohol and substance use-related research in IeDEA has been significantly hampered by the lack of routinely available alcohol and substance use data.…”

Section: Alcohol and Other Substance Usementioning

confidence: 99%

Sentinel Research Network (SRN) of IeDEA: Study Protocol

Jaquet¹,

Anastos²,

Chihota³

et al. 2020

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BACKGROUND The global scale up of antiretroviral therapy (ART) has significantly improved the immune recovery and life expectancy of people living with HIV (PLHIV). However, PLHIV on long-term ART now face health challenges related to non-communicable diseases (NCDs). We know that exposures such as tobacco, alcohol, diet and exercise are associated with the risk of NCDs. In addition, alcohol is one of the most commonly used substances globally and unhealthy drinking commonly co-occurs with mental health disorders. However, limited data are available in low- and middle-income country (LMIC) settings on the intersection between HIV, NCDs, mental health, and use of alcohol and other substances. As the population of PLHIV increases and ages, it is imperative that we understand the burden of NCDs and risk factors for NCD development as well as their impact on long-term health outcomes.AIMS To establish a network of research sites, the Sentinel Research Network (SRN), and to capture and analyze standardized data among PLHIV in LMICs. Through this network, we further seek to implement studies on cardiovascular risk factors, mental health, alcohol and other substance use disorders, as well as liver disease prevalence and associated factors among PLHIV accessing care in LMICs.METHODS Create a “sentinel” cohort nested in the pre-existing regional networks of the International epidemiologic Databases to Evaluate AIDS (IeDEA) cohorts based in LMICs. A total of six IeDEA research sites located in Brazil, Côte d’Ivoire, India, Kenya, Rwanda and Zambia are expected to recruit a total of 1 375 people with HIV ≥40 years and on ART ≥6 months. These participants will be assessed at baseline for various chronic conditions and their risk factors, including diabetes, dyslipidemia, hypertension, drug and alcohol abuse, as well as chronic liver diseases, through standardized questionnaires and non-to-minimally invasive “bedside” screening tests. Follow-up visits are planned at month six and month twelve for reassessment of these chronic conditions. Data prospectively collected through the SRN will be merged with pre-existing HIV-related data routinely collected through IeDEA cohorts.EXPECTED RESULTS To date, the IeDEA consortium houses data on nearly 1.5 million adults and 150,000 children and adolescents living with HIV and has been studying treatment and other HIV-related outcomes since 2006. The establishment of the SRN will allow IeDEA investigators to better evaluate additional risk factors and co-morbidities associated with aging and HIV in standardized ways. Through the SRN, IeDEA will also develop the research infrastructure needed to enhance the design and validation of data collection tools related to these co-morbidities.

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Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities

Cited by 29 publications

References 97 publications

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study

International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012–2019

Sentinel Research Network (SRN) of IeDEA: Study Protocol

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