Browsing by Author "Cheng, Debbie M."
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Item Alcohol Consumption in Ugandan HIV-infected Household-brewers Versus Non-brewers(AIDS and Behavior, 2016) Thakarar, Kinna; Asiimwe, Stephen B.; Cheng, Debbie M.; Forman, Leah; Ngabirano, Christine; Muyindike, Winnie R.; Emenyonu, Nneka I.; Samet, Jeffrey H.; Hahn, Judith A.The brewing of alcohol in Ugandan households is common, yet little is known about its relationship with alcohol consumption in HIV-infected individuals. We performed a cross-sectional analysis to assess the association between household brewing and unhealthy alcohol consumption among 387 HIV-infected adults in a prospective study examining the association between alcohol consumption and HIV-disease progression. Household brewing was defined as participants reporting that they or a household member home-brewed alcohol. Logistic regression was used to assess the association between household brewing and unhealthy alcohol consumption, defined as phosphatidylethanol (PEth) level ≥ 50 ng/ml or AUDIT-C (modified to measure the prior 3 months) positive. Sixty-six (17.0%) participants reported household brewing. Household brewers had higher odds of unhealthy alcohol consumption (AOR 2.27, 95% CI 1.26–4.12).Item Alcohol Use and Food Insecurity among People Living with HIV in Mbarara, Uganda and St. Petersburg, Russia(AIDS and Behavior, 2017) Patts, Gregory J.; Cheng, Debbie M.; Emenyonu, Nneka; Bridden, Carly; Gnatienko, Natalia; Lloyd-Travaglini, Christine A.; Ngabirano, Christine; Yaroslavtseva, Tatiana; Muyindike, Winnie R.; Weiser, Sheri D.; Krupitsky, Evgeny M.; Hahn, Judith A.; Samet, Jeffrey H.Food insecurity (FI) is a documented problem associated with adverse health outcomes among HIV-infected populations. Little is known about the relationship between alcohol use and FI. We assessed whether heavy alcohol use was associated with FI among HIV-infected, antiretroviral therapy (ART)-naïve cohorts in Uganda and Russia. Inverse probability of treatment weighted logistic regression models were used to evaluate the association using cross-sectional baseline data. FI was experienced by half of the Russia cohort (52%) and by a large majority of the Uganda cohort (84%). We did not detect an association between heavy alcohol use and FI in either cohort (Russia: AOR = 0.80, 95% CI = 0.46, 1.40; Uganda: AOR = 1.00, 95% CI = 0.57, 1.74) or based on the overall combined estimate (AOR = 0.89, 95% CI = 0.60, 1.33). Future studies should explore the determinants of FI in HIV-infected populations to inform strategies for its mitigation.Item Alcohol Use and HIV Disease Progression in an Antiretroviral Naïve Cohort(Journal of acquired immune deficiency syndromes, 2018) Hahn, Judith A.; Cheng, Debbie M.; Emenyonu, Nneka I.; Lloyd-Travaglini, Christine; Fatch, Robin; Shade, Starley B.; Ngabirano, Christine; Adong, Julian; Bryant, Kendall; Muyindike, Winnie R.; Samet, Jeffrey H.Alcohol use has been shown to accelerate disease progression in experimental studies of simian immunodeficiency virus in macaques, but the results in observational studies of HIV have been conflicting. We conducted a prospective cohort study of the impact of unhealthy alcohol use on CD4 cell count among HIV-infected persons in southwestern Uganda not yet eligible for antiretroviral treatment (ART). Unhealthy alcohol consumption was 3-month Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive (≥3 for women, ≥4 for men) and/or phosphatidylethanol (PEth - an alcohol biomarker) ≥50 ng/ml, modeled as a time-dependent variable in a linear mixed effects model of CD4 count.Item Alcohol use and unprotected sex among HIV-infected Ugandan adults: Findings from an event-level study(Archives of sexual behavior, 2018) Woolf-King, Sarah E.; Fatch, Robin; Cheng, Debbie M.; Muyindike, Winnie; Ngabirano, Christine; Kekibiina, Allen; Emenyonu, Nneka; Hahn, Judith A.While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine if alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner-type) of the Most Recent Sexual Event (MRSE). Generalized estimating equation (GEE) logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner-type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1,817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one’s sexual partner (aOR) = 1.70; 95%CI = 1.14, 2.54) or by both partners (aOR: 1.78; 95%CI: 1.07, 2.98), during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event, and subsequent unprotected sex.Item Assessing the Interaction between Depressive Symptoms and Alcohol Use Prior to Antiretroviral Therapy on Viral Suppression among People Living with HIV in Rural Uganda(AIDS care, 2020) Foley, Jacklyn D.; Sheinfil, Alan; Woolf-King, Sarah E.; Fatch, Robin; Emenyonu, Nneka I.; Muyindike, Winnie R.; Kekibiina, Allen; Ngabirano, Christine; Samet, Jeffrey H.; Cheng, Debbie M.; Hahn, Judith A.Although there is evidence of individual associations between depressive symptoms and hazardous alcohol use with suboptimal antiretroviral therapy (ART) adherence among people living with HIV (PLWH), few studies have established how the two risk factors may interact to predict viral suppression. We conducted secondary data analyses with two cohorts of Ugandan PLWH (N = 657) to investigate the hypothesized interaction between depressive symptoms (Center for Epidemiological Studies Depression Scale) and hazardous alcohol use (Alcohol Use Disorder Identification Test – Consumption and/or Phosphatidylethanol biomarker) prior to ART initiation with viral suppression (<550 copies/ml). We were unable to detect an interaction between depressive symptoms and hazardous alcohol use prior to ART initiation with viral suppression in the first two years (M = 19.9 months) after ART initiation (p = 0.75). There was also no evidence of a main effect association for depressive symptoms (Adjusted Odds Ratio [AOR] = 0.88, 95% Confidence Interval [CI]: 0.50, 1.55) or hazardous alcohol use (AOR = 1.37, 95% CI: 0.80, 2.33). PLWH with depressive symptoms and/or hazardous alcohol use appear to exhibit similar levels of viral suppression as others in care; further work is needed to determine effects on HIV testing and treatment engagement.Item Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda(AIDS Care, 2017) Muyindike, Winnie R.; Lloyd-Travaglini, Christine; Fatch, Robin; Emenyonu, Nneka I.; Adong, Julian; Ngabirano, Christine; Cheng, Debbie M.; Winter, Michael R.; Samet, Jeffrey H.; Hahn, Judith A.Under-reporting of alcohol use by HIV-infected patients could adversely impact clinical care. This study examined factors associated with under-reporting of alcohol consumption by patients who denied alcohol use in clinical and research settings using an alcohol biomarker. We enrolled ARTnaïve, HIV-infected adults at Mbarara Hospital HIV clinic in Uganda. We conducted baseline interviews on alcohol use, demographics, Spirituality and Religiosity Index (SRI), health and functional status; and tested for breath alcohol content and collected blood for phosphatidylethanol (PEth), a sensitive and specific biomarker of alcohol use. We determined PEth status among participants who denied alcohol consumption to clinic counselors (Group 1, n = 104), and those who denied alcohol use on their research interview (Group 2, n = 198). A positive PEth was defined as ≥8 ng/ml. Multiple logistic regression models were used to examine whether testing PEth-positive varied by demographics, literacy, spirituality, socially desirable reporting and physical health status. Results showed that, among the 104 participants in Group 1, 28.8% were PEth-positive. The odds of being PEth-positive were higher for those reporting prior unhealthy drinking (adjusted odds ratio (AOR): 4.7, 95% confidence interval (CI): 1.8, 12.5). No other factors were statistically significant. Among the 198 participants in Group 2, 13.1% were PEth-positive. The odds of being PEth-positive were higher for those reporting past unhealthy drinking (AOR: 4.6, 95% CI: 1.8, 12.2), the Catholics (AOR: 3.8, 95% CI: 1.3, 11.0) compared to Protestants and lower for the literate participants (AOR: 0.3, 95% CI: 0.1, 0.8). We concluded that under-reporting of alcohol use to HIV clinic staff was substantial, but it was lower in a research setting that conducted testing for breath alcohol and PEth. A report of past unhealthy drinking may highlight current alcohol use among deniers. Strategies to improve alcohol self-report are needed within HIV care settings in Uganda.Item The relationship between spirituality/religiousness and unhealthy alcohol use among HIV-infected adults in southwestern Uganda(AIDS and Behavior, 2018) Adong, Julian; Lindan, Christina; Fatch, Robin; Emenyonu, Nneka I.; Muyindike, Winnie R.; Ngabirano, Christine; Winter, Michael R.; Lloyd-Travaglini, Christine; Samet, Jeffrey H.; Cheng, Debbie M.; Hahn, Judith A.HIV and alcohol use are two serious and co-existing problems in sub-Saharan Africa. We examined the relationship between spirituality and/or religiousness (SR) and unhealthy alcohol use among treatment-naïve HIV-infected adults attending the HIV clinic in Mbarara, Uganda. Unhealthy alcohol was defined as having either an Alcohol Use Disorders Identification Test – Consumption score of ≥4 for men or ≥3 for women, or having a phosphatidylethanol level of ≥50ng/ml based on analysis of dried blood-spot specimens. Of the 447 participants, 67.8% were female; the median age was 32 years (interquartile range [IQR]: 27–40). About half reported being Protestant (49.2%), 35.1 % Catholic, and 9.2% Muslim. The median SR score was high (103 [IQR: 89–107]); 43.3% drank at unhealthy levels. Higher SR scores were associated with lower odds of unhealthy drinking (adjusted odds ratio [aOR]: 0.83 per standard deviation [SD] increase; 95% confidence interval [CI] 0.66–1.03). The “religious behavior” SR sub-scale was significantly associated with unhealthy alcohol use (aOR: 0.72 per SD increase; 95% CI 0.58–0.88). Religious institutions, which facilitate expression of religious behavior, may be helpful in promoting and maintaining lower levels of alcohol use.Item Tuberculin skin test positivity among HIV infected alcohol drinkers on antiretrovirals in south-western Uganda(PLoS ONE, 2020) Muyindike, Winnie R.; Fatch, Robin; Cheng, Debbie M.; Emenyonu, Nneka I.; Ngabirano, Christine; Adong, Julian; Linas, Benjamin P.; Jacobson, Karen R.; Hahn, Judith A.Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH), and current evidence suggests that heavy alcohol users have an increased risk of developing TB disease compared to non-drinkers. Not known is whether the increased risk for TB disease among alcohol users may reflect higher rates of latent TB infection (LTBI) among this population. We assessed the latent TB infection prevalence based on tuberculin skin testing (TST) and examined association with current alcohol use among HIV-infected persons on antiretroviral therapy (ART) in south-western Uganda. We included PLWH at the Mbarara Regional Hospital HIV clinic, who were either current alcohol consumers (prior 3 months) or past year abstainers (2:1 enrolment ratio). Participants were recruited for a study of isoniazid preventive therapy for LTBI. TST was performed using 5 tuberculin units of purified protein derivative. The primary outcome was a positive TST reading (5mm induration), reflecting LTBI. We used logistic regression analyses to assess the cross-sectional association between self-reported current alcohol use and a positive TST.Item Unhealthy Alcohol Use is Associated with Monocyte Activation Prior to Starting Anti-Retroviral Therapy(Clinical and Experimental Research, 2015) Carrico, Adam W.; Hunt, Peter W.; Emenyonu, Nneka I.; Muyindike, Winnie; Ngabirano, Christine; Cheng, Debbie M.; Winter, Michael R.; Samet, Jeffrey H.; Hahn, Judith A.Alcohol use may accelerate HIV disease progression, but the plausible biological mechanisms have not been clearly elucidated. HIV-positive persons who were not on anti-retroviral therapy (ART) completed the baseline assessment for a longitudinal study examining the association of alcohol use with HIV disease markers. Oversampling drinkers, baseline samples were tested for markers of monocyte activation (sCD14), inflammation (IL-6), and coagulation (D-dimer). We defined “unhealthy alcohol use” as testing positive using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C; ≥ 3 for women and ≥ 4 for men) in the past 3 months or testing positive using a biomarker of heavy drinking, phophatidylethanol (PEth; ≥ 50 ng/ml). Multiple linear regression was used to examine the associations of unhealthy alcohol use with sCD14, Log10 IL-6, and D-dimer.