Browsing by Author "Muyindike, Winnie"
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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 Challenges Associated with the Roll-out of HCC Surveillance in Sub-Saharan Africa - the Case of Uganda(Journal of Hepatology, 2020) Hees, Stijn Van; Muyindike, Winnie; Erem, Geoffrey; Ocama, Ponsianoo; Seremba, Emmanuel; Apiyo, Paska; Michielsen, Peter; Okwir, Mark; Vanwolleghem, ThomasIn their recent review article, Singal and coworkers describe the challenges associated with surveillance for hepatocellular carcinoma (HCC) and propose interventions to increase the effectiveness of surveillance. We agree with the authors that improved uptake of screening and performance of HCC surveillance should be considered a high priority in Western countries. In sub-Saharan Africa, where HBV infections are the main cause of HCC, surveillance programs are mostly not available. Nonetheless, with an incidence rate of 8.9 cases per 100,000 inhabitants per year, which is likely to be an underestimate, HCC surveillance is a pressing medical need in this part of the world. The recent introduction of country-wide vaccination programs in these countries will likely result in a drop in HCC incidence a few decades from now, but this does not apply to patients that are currently infected. In a recent African cohort of 1,315 hepatocellular tumors, 84% of the tumors were diagnosed at a late, multifocal disease stage with a mean size of 8 ± 4 cm and a median survival of 2.5 months.Given the strong association between early detection and improved survival, these findings highlight the need to set up surveillance programs in sub-Saharan Africa, provided curative treatment options are available.Item Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care(AIDS and Behavior, 2022) Young, Cynthia R.; Gill, Elizabeth; Bwana, Mwebesa; Muyindike, Winnie; Hock, Rebecca S.; Pratt, Madeline C.; Owembabazi, Moran; Tukwasibwe, · Deogratius; Najjuma, Alice; Kalyebara, Paul; Natukunda, Silvia; Kaida, Angela; Matthews, Lynn T.Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.Item Contraceptive use following unintended pregnancy among Ugandan women living with HIV(PLoS ONE, 2018) Jarolimova, Jana; Kabakyenga, Jerome; Bennett, Kara; Muyindike, Winnie; Kembabazi, Annet; Martin, Jeffrey N.; Hunt, Peter W.; Boum, Yap; Haberer, Jessica E.; Bangsberg, David R.; Kaida, Angela; Matthews, Lynn T.Preventing unintended pregnancy is critical for women living with HIV (WLWH) to safely achieve their reproductive goals. Family planning services should support WLWH at risk of repeat unintended pregnancies. We examined the relationship between unintended pregnancy and subsequent contraception use among WLWH in Uganda. This was a retrospective analysis of data from a longitudinal cohort of individuals initiating antiretroviral therapy (ART), restricted to women with pregnancy (confirmed via urine β-hcg testing) between 2011–2013. The exposure of interest was intended vs unintended pregnancy, and the outcome was self-report of modern contraceptive use (hormonal methods, intrauterine device, sterilization, and/or consistent condom use) at 12 (range 6–18) months post-partum. A log-binomial model was used to estimate relative risks of modern contraceptive use post-partum based on intent of the index pregnancy, adjusted for age, socioeconomic status, education, relationship and HIV status of pregnancy partner, contraceptive use prior to pregnancy, years since HIV diagnosis, ART regimen, and CD4 cell count.Item Cost-effectiveness analysis of integrating screening and treatment of selected non-communicable diseases into HIV/AIDS treatment in Uganda(Journal of the International AIDS Society, 2020) Sando, David; Kintu, Alexander; Okello, Samson; Kawungezi, Peter Chris; Guwatudde, David; Mutungi, Gerald; Muyindike, Winnie; Menzies, Nicolas A.; Danaei, Goodarz; Verguet, StephaneDespite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost-effectiveness of basic NCD-HIV integration in a Ugandan setting. Methods: We developed an epidemiologic-cost model to analyze, from the provider perspective, the cost-effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization’s STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability-adjusted life years were estimated over 10 subsequent years along with incremental cost-effectiveness of the integration. Results: Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10-year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability-adjusted life year averted among older ART patients. Conclusions: Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost-effectiveness comparable to other standalone interventions to address NCDs in low- and middle-income country settings.Item High incidence of intended partner pregnancy among men living with HIV in rural Uganda: Implications for safer conception services(Journal of acquired immune deficiency syndromes, 2019) Kaida, Angela; Kabakyenga, Jerome; Bwana, Mwebesa; Bajunirwe, Francis; Muyindike, Winnie; Bennett, Kara; Kembabazi, Annet; Haberer, Jessica E.; Boum, Yap; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.; Matthews, Lynn T.Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy (ART) in Uganda.Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men’s sexual and reproductive health annually and repeated at time of reported pregnancy (2011–2015). We measured partner pregnancy incidence overall, by pregnancy intention, and by reported partner HIV-serostatus. We assessed viral suppression (≤400 copies/mL) during the peri-conception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy.Among 189 men, baseline median age was 39.9 years [IQR:34.7,47.0], years on ART was 3.9 [IQR:0.0,5.1], and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence=16.0/100 person-years); 45% with HIV-serodifferent partners. By three years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV-serostatus (p=0.75). 69% of pregnancies were intended, 18% wanted but mis-timed, and 8% unwanted. 78% of men were virally suppressed prior to pregnancy report. Men who were younger (aHR:0.94/year;95%CI:0.89–0.99), had incomplete primary education (aHR:2.95;95%CI:1.36–6.40), and reported fertility desires (aHR:2.25;95%CI:1.04–4.85) had higher probability of partner pregnancy.A high incidence of intended partner pregnancy highlights the need to address men’s reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV and one-quarter of men were not virally suppressed during peri-conception. Safer conception care provides opportunity to support men’s health and reproductive goals, while preventing HIV transmission to women and infants.Item 'I still desire to have a child': a qualitative analysis of intersectional HIV- and childlessness-related stigma in rural southwestern Uganda(Taylor & Francis, 2023-02) Pratt, Madeline C; Owembabazi, Moran; Muyindike, Winnie; Kaida, Angela; Marrazzo, Jeanne M; Bangsberg, David R; Bwana, Mwebesa B; Psaros, Christina; Turan, Janet; Atukunda, Esther C; Matthews, Lynn T.Abstract This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer conception strategies. This secondary analysis explored how challenges conceiving informed pregnancy plans and HIV prevention behaviours. The following themes were developed (1) partnership conflicts arise from HIV- and infertility-related forms of stigma, contributing to gender-based violence, partnership dissolution and the pursuit of new partners; (2) cultural and gender norms pressure men and women to conceive and maintain partnerships, which is complicated by the stigma directed towards serodifferent couples; (3) frustration with low partner participation in safer conception strategies led to the decreased use of these methods of HIV prevention; (4) health care provider support promotes continued hope of conception and helps overcome stigma. In HIV-affected partnerships, these intersecting forms of stigma may impact HIV prevention. Seeking to fulfil their reproductive needs, partners may increase HIV transmission opportunities as they engage in condomless sex with additional partners and decrease adherence to prevention strategies. Future research programmes should consider the integration of fertility counselling with reproductive and sexual health care.Item Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study(Public Library of Science, 2024-04) Appa, Ayesha; Miller, Amanda P; Fatch, Robin; Kekibiina, Allen; Beesiga, Brian; Adong, Julian; Emenyonu, Nneka; Marson, Kara; Getahun, Monica; Kamya, Moses; Muyindike, Winnie; McDonell, Michael; Thirumurthy, Harsha; Hahn, Judith A; Chamie, Gabriel; Camlin, Carol SEconomic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants’ experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers’ Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of “winning” through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.Item Prevalence and factors associated with adverse drug events among patients on dolutegravir‑based regimen at the Immune Suppression Syndrome Clinic of Mbarara Regional Referral Hospital, Uganda: a mixed design study(AIDS Research and Therapy, 2022) Namulindwa, Angella; Wasswa, John Hans; Muyindike, Winnie; Tamukong, Robert; Oloro, JosephIn low income countries such as Uganda progress has been made towards achieving the United Nations AIDS programme 95-95-95 target however efforts are still impeded by pretreatment drug resistance and adverse drug events (ADEs) hence introduction of dolutegravir-based antiretroviral therapy as first-line treatment due to a higher genetic barrier to resistance, better tolerability and safety profile. However, recent studies have raised concerns regarding its safety in real-clinical settings due to ADEs and being a recently introduced drug there is need to actively monitor for ADEs, hence this study aimed to establish the prevalence and factors associated with ADEs among patients on dolutegravir-based regimen at the Immune Suppression Syndrome (ISS) Clinic- Mbarara Regional Referral Hospital (MRRH). Methods: A mixed design study was conducted at ISS Clinic-MRRH among 375 randomly selected patients who had been exposed to DTG-based regimen for at-least 12 weeks. These were interviewed to obtain data on sociodemographics, dietary habits and their files reviewed for ADEs. Data entry was done using Epi-data 3.0 and exported to SPSS 25.0 for analysis. Prevalence was determined as a percentage, and ADE associated factors assessed using bivariate analysis, those found significant were further subjected to multivariate analysis and considered significant at P < 0.05. Results: The prevalence of ADEs among patients on DTG-based regimen was found to be 33.1% (124/375) with 5.6% (7/124) participants discontinued from treatment due ADEs, 4 due to hyperglycemia and 3 liver toxicity. The commonly experienced ADE was allergy at 36.3%. Male sex (AOR 1.571, 95% CI 1.433–1.984), WHO stage one at entry to care (AOR 4.586, 95% CI 1.649–12.754), stage two (AOR 4.536, 95% CI 1.611–12.776), stage three (AOR 3.638, 95% CI 1.262–10.488), were significantly associated with ADEs. Patients with undetectable viral load at initiation of DTG-based regimen were 67.6% less likely to experience ADEs (AOR = 0.324, 95% CI 0.1167–0.629). Conclusion: This study reports a prevalence of 33.1% of ADEs among patients on DTG-based regimen. The most commonly experienced ADE was allergy. Male sex, early HIV disease stage at entry into care and detectable viral load at initiation of DTG-based regimenItem Quantifying the burden of cardiovascular diseases among people living with HIV in sub-Saharan Africa: findings from a modeling study for Uganda(Journal of Global Health Reports, 2020) Kintu, Alexander; Sando, David; Guwatudde, David; Bahendeka, Silver; Kawungezi, Peter C.; Mutungi, Gerald; Muyindike, Winnie; Menzies, Nicolas; Okello, Samson; Danaei, Goodarz; Verguet, StéphaneThe burden of non-communicable diseases (NCDs) is rapidly increasing in low- and middle-income countries, but remains largely unknown among people living with HIV (PLWH) in most sub-Saharan African countries. Methods We estimated the proportion of PLWH in Uganda with raised blood pressure and high total cholesterol, and used a modified cardiovascular disease (CVD) risk prediction model (Globorisk) to assess the 10-year risk of atherosclerotic cardiovascular disease using individual-level data on cardiometabolic risk factors, population-level data on HIV prevalence and ART coverage, and the impact of HIV on blood pressure and cholesterol. Results Among PLWH aged 30 to 69 years, the prevalence of raised blood pressure was 30% (95% uncertainty range, UR=27-33%) in women and 26% in men (95% UR=23-29%). The predicted mean 10-year CVD risk was 5% for HIV-infected women, and 6% for HIV-infected men. Five percent (n=41,000) of PLWH may experience a CVD event from 2016 to 2025 with an estimated 38% of these events being fatal. Full ART coverage would have little effect on the predicted number of CVD cases. Conclusions Despite having a high prevalence of raised blood pressure, the burden of atherosclerotic CVD among PLWH in Uganda remains low. ART programs should prioritize routine screening and treatment of raised blood pressure. An approach of using HIV treatment delivery platforms to deliver care for NCDs may miss the larger burden of disease among HIV-uninfected individuals that are not routinely seen at health facilities.Item Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa(Annals of Internal Medicine, 2021) Siedner, Mark J.; Moosa, Mahomed-Yunus S.; McCluskey, Suzanne; Gilbert, Rebecca F.; Pillay, Selvan; Aturinda, Isaac; Ard, Kevin; Muyindike, Winnie; Musinguzi, Nicholas; Masette, Godfrey; Pillay, Melendhran; Moodley, Pravikrishnen; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Gandhi, Rajesh T.; Johnson, Brent A.; Sunpath, Henry; Bwana, Mwebesa B.; Marconi, Vincent C.Virologic failure in HIV remains a major public health threat in sub-Saharan Africa. It occurs in approximately 10% to 30% of patients within 2 years of antiretroviral therapy (ART) initiation and is associated with development of drug resistance, increased risk for opportunistic infections and death, and ongoing transmission of HIV (1–6). The optimal management of virologic failure is unknown. Guidelines published by the U.S. Department of Health and Human Services recommend genotypic resistance testing (GRT) to assist in the management of virologic failure (7). Small randomized trials and observational studies completed in the early ART era in the United States suggested that GRT has benefit in virologic control and selection of active regimens (8–11). However, GRT after failure of first-line therapy is not routinely supported by treatment guidelines by the World Health Organization and is not typically done in most sub-Saharan African countries (12).Item Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid efectiveness-implementation trial(BioMed Central Ltd, 2024-07) Sundararajan, Radhika; Hooda, Misha; Lai, Yifan; Nansera, Denis; Audet, Carolyn; Downs, Jennifer; Lee, Myung Hee; McNairy, Margaret; Muyindike, Winnie; Mwanga-Amumpaire, JulietRural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research.BACKGROUNDRural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research.This cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment.METHODSThis cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment.The Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health.DISCUSSIONThe Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health.ClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).TRIAL REGISTRATIONClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023). MEDLINE - AcademicItem 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.