Browsing by Author "Winter, Michael R."

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    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.
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    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.
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    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.