Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Drug and Alcohol Dependence
Abstract
Background: Alcohol use is common among persons living with HIV (PWH) in Uganda and
associated with poor HIV care outcomes; findings regarding the relationship between alcohol use
and viral suppression (VS) have been inconclusive.
Methods: Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open
population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol
exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable
models (GEE) were used to estimate associations between alcohol exposures and VS for the
overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by
ART use was explored.
Results: Over half (55%) of participants (n=3,823 PWH) reported alcohol use at baseline; 37.8%
of those reporting alcohol use reported alcohol-related consequences. ART use and VS at
baseline significantly differed by alcohol use with person reporting alcohol use being less likely
to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among
women but not men (adj. OR 0.72 95% CI 0.58-0.89, p=0.0031). However, among males who
use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95% CI 0.54-0.88, p=0.0034). The relationships between
both alcohol exposures and VS were not significant in models restricted to persons on ART.
Conclusions: We provide sex-stratified estimates of associations between two alcohol measures
and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use
is adversely associated with VS but ART use mediates this pathway, suggesting that initiation
and retention on ART are critical steps to addressing alcohol-related disparities in VS.
Description
Keywords
Uganda, Alcohol, HIV care continuum, Viral suppression, Treatment adherence
Citation
Miller AP, Pitpitan EV, Kiene SM, Raj A, Jain S, Z´u˜niga ML, Nabulaku D, Nalugoda F, Ssekubugu R, Nantume B, Kigozi G, Sewankambo NK, Kagaayi J, Reynolds SJ, Grabowski K, Wawer M, A. Wagman J, Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda, Drug and Alcohol Dependence (2021), doi: https://doi.org/10.1016/j.drugalcdep.2021.109005