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

Abstract

Objective Using daily diary methods, we aimed to test the hypothesis that at the event-level consuming alcohol increases the likelihood that antiretrovirals (ARV) will be missed on a particular day. Methods This prospective cohort study of 74 (52 female, 22 male) PLHIV in South Africa collected event-level data on ARV adherence and alcohol consumption using structured daily phone interviews over a period of 42 days generating 2,718 data points. We used generalized estimating equations (GEE) analyses to assess univariate and multivariate associations between alcohol and adherence, controlling for sociodemographics and testing for effect modification. Results Controlling for sociodemographics, each alcohol measure was a statistically significant predictor of non-adherence on a particular day; any drinking compared to no drinking (daytime: AOR = 3.18, 95% CI = 2.25–4.49; evening: AOR = 3.43, 95% CI = 2.13–5.53), consuming more alcohol than one normally consumes (daytime: AOR = 1.06, 95% CI = 1.02–1.11; evening: AOR = 1.10, 95% CI = 1.05–1.15), and drinking at low to moderate risk level (daytime: 4.29, 95% CI = 2.81–6.56; evening: AOR = 4.24, 95% CI =2.38–7.54) and high to very high risk levels (daytime: AOR = 2.31, 95% CI = 1.56–3.42; evening: AOR = 3.08, 95% CI = 1.91–4.98) were all significantly related to missing ARVs in the daytime and evening. Conclusions These data provide support for an event-level relationship between alcohol and non-adherence. Interventions that mitigate alcohol use among people on ARVs or provide strategies to maintain optimal adherence among those who drink are needed.

Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

“…Our study also shows that alcohol use significantly influenced postpartum adherence to ART, which is consistent with previous studies [17,25,26]. Alcohol users were fifty-three percent less likely to adhere to ART compared to non-users.…”

“…Alcohol users tend to drink in company of friends on nights out and in parties, which makes them forget to use their medications [17]. Also, it appears that people believe that they can not use their medication as well as take alcohol making them to sometimes forgo ART in order to take alcohol [25,26]. Young people are more likely to use alcohol compared to adults [27], and this may explain why adherence is poor among young women compared to older adults.…”

Hazardous alcohol consumption and alcohol-related problems are associated with unknown and HIV-positive status in fishing communities in Uganda

“…More than a third of individuals aware of their HIV positive status reported co-occurring hazardous alcohol use and alcohol-related problems, which is of great concern since highrisk alcohol use is associated with poor antiretroviral adherence and poor treatment outcomes (Kahler et al, 2016;Sileo, Simbayi, Abrams, Cloete, & Kiene, 2016). Furthermore, we note that rates of hazardous alcohol use and alcohol-related problems were no different between individuals who had never tested for HIV and those who reported being HIV positive (analysis not shown).…”

The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study

“…Evidence suggests that religious involvement is prospectively related to lower alcohol use problems, and lower consumption among those who drink (34,35). Problematic alcohol use can impede ART adherence (36)(37)(38) and increase the progression from HIV to AIDS (39) that heightens transmission risk in the population (40). Findings from this study's cohort documented a 29% lower odds of ART adherence for each 10% increase in alcohol problems (41).…”