Abstract:
Objectives
Almost 13 million people are estimated to be on anti retroviral therapy in Eastern and Southern Africa, and their disease course and program effectiveness could be significantly
affected by the concurrent use of alcohol. Screening for alcohol use may be important to
assess the prevalence of alcohol consumption and its impact on patient and programmatic
outcomes.
Methods
As part of this observational study, data on patient characteristics and alcohol consumption
were collected on a cohort of 765 adult patients enrolling in HIV care in East Africa. Alcohol
consumption was assessed with the AUDIT questionnaire at enrollment. Subjects were
classified as consuming any alcohol (AUDIT score >0), hazardous drinkers (AUDIT score
�8) and hyper drinkers (AUDIT score �16). The effects of alcohol consumption on retention
in care, death and delays in anti retroviral therapy (ART) initiation were assessed through
competing risk (Fine & Gray) models.
Results
Of all study participants, 41.6% consumed alcohol, 26.7% were classified as hazardous
drinkers, and 16.0% as hyper drinkers. Depending on alcohol consumption classification,
men were 3–4 times more likely to consume alcohol compared to women. Hazardous drinkers (median age 32.8 years) and hyper drinkers (32.7 years) were slightly older compared to non-hazardous drinkers (30.7 years) and non-hyper drinkers (30.8 years), (p-values = 0.014
and 0.053 respectively). Median CD4 at enrollment was 330 cells/μl and 16% were classified World Health Organization (WHO) stage 3 or 4. There was no association between
alcohol consumption and CD4 count or WHO stage at enrollment. Alcohol consumption was
associated with significantly lower probability of ART initiation (adjusted sub-distribution
hazard ratio aSHR = 0.77 between alcohol consumers versus non-consumers; p-value =
0.008), and higher patient non-retention in care (aSHR = 1.77, p-value = 0.023).
Discussion
Alcohol consumption is associated with significant delays in ART initiation and reduced
retention in care for patients enrolling in HIV care and treatment programs in East Africa.
Consequently, interventions that target alcohol consumption may have a significant impact
on the HIV care cascade.