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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

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



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


Cross-sectional analyses.


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.


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.


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

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