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AIDS. 2019 Nov 12. doi: 10.1097/QAD.0000000000002427. [Epub ahead of print]

Associations between alcohol use and HIV care cascade outcomes among adults undergoing population-based HIV testing in East Africa.

Author information

1
Division of HIV, Infectious Diseases and Global Medicine.
2
Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California.
3
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA.
4
Kenya Medical Research Institute, Kisumu, Kenya.
5
Infectious Diseases Research Collaboration, Kampala, Uganda.
6
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.
7
Makerere University College of Health Sciences, Kampala, Uganda.
8
Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA.

Abstract

OBJECTIVE:

To assess the impact of alcohol use on HIV care cascade outcomes.

DESIGN:

Cross-sectional analyses.

METHODS:

We evaluated HIV care cascade outcomes and alcohol use in adults (≥15 years) during baseline (2013--2014) population-based HIV testing in 28 Kenyan and Ugandan communities. 'Alcohol use' included any current use and was stratified by Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scores: nonhazardous/low (1--3 men/1--2 women), hazardous/medium (4--5 men/3--5 women), hazardous/high (6--7), hazardous/very-high (8--12). We estimated cascade outcomes and relative risks associated with each drinking level using targeted maximum likelihood estimation, adjusting for confounding and missing measures.

RESULTS:

Among 118 923 adults, 10 268 (9%) tested HIV-positive. Of those, 10 067 (98%) completed alcohol screening: 1626 (16%) reported drinking, representing 7% of women (467/6499) and 33% of men (1 159/3568). Drinking levels were: low (48%), medium (34%), high (11%), very high (7%). Drinkers were less likely to be previously HIV diagnosed (58% [95% CI: 55--61%]) than nondrinkers [66% (95% CI: 65-67%); RR: 0.87 (95% CI: 0.83-0.92)]. If previously diagnosed, drinkers were less likely to be on ART [77% (95% CI: 73-80%)] than nondrinkers [83% (95% CI 82-84%); RR: 0.93 (95% CI: 0.89-0.97)]. If on ART, there was no association between alcohol use and viral suppression; however, very-high-level users were less likely to be suppressed [RR: 0.80 (95% CI: 0.68-0.94)] versus nondrinkers. On a population level, viral suppression was 38% (95% CI: 36-41%) among drinkers and 44% (95% CI: 43-45%) among nondrinkers [RR: 0.87 (95% CI 0.82-0.94)], an association seen at all drinking levels.

CONCLUSION:

Alcohol use was associated with lower viral suppression; this may be because of decreased HIV diagnosis and ART use.

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