1
|
Myers B, Regenauer KS, Johnson K, Brown I, Rose A, Ciya N, Ndamase S, Jacobs Y, Anvari M, Hines A, Dean D, Baskar R, Magidson J. A stakeholder-driven approach to designing a peer recovery coach role for implementation in community-oriented primary care teams in South Africa. RESEARCH SQUARE 2024:rs.3.rs-4566640. [PMID: 39070655 PMCID: PMC11275972 DOI: 10.21203/rs.3.rs-4566640/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Introduction In South Africa (SA), community-oriented primary care (COPC) teams work to re-engage out-of-care people with HIV (PWH) in treatment, many of whom have substance use (SU) concerns. SU stigma is high among these teams, limiting care engagement efforts. Integrating peer recovery coaches (PRCs) into COPC teams could shift SU stigma and improve patients' engagement in care. The PRC role does not exist in SA and represents a workforce innovation. To enhance acceptability, feasibility, and appropriateness for the local context, we engaged multiple stakeholder groups to co-design a PRC role for COPC team integration. Methods We used a five-step human-centered design process: (i) semi-structured interviews with healthcare worker (HCW, n = 25) and patient (n = 15) stakeholders to identify priorities for the role; (ii) development of an initial role overview; (iii) six ideation workshops with HCW (n = 12) and patient (n = 12) stakeholders to adapt this overview; (iv) refinement of the role prototype via four co-design workshops with HCW (n = 7) and patient (n = 9) stakeholders; and (v) consultation with HIV and SU service leaders to assess the acceptability and feasibility of integrating this prototype into COPC teams. Results Although all stakeholders viewed the PRC role as acceptable, patients and HCWs identified different priorities. Patients prioritized the care experience through sharing of lived experience and confidential SU support. HCWs prioritized clarification of the PRC role, working conditions, and processes to limit any impact on the COPC team. A personal history of SU, minimum 1 year in SU recovery, and strong community knowledge were considered role prerequisites by all stakeholders. Through the iterative process, stakeholders clarified their preferences for PRC session structure, location, and content and expanded proposed components of PRC training to include therapeutic and professional work practice competencies. Service leaders endorsed the prototype after the addition of PRC integration training for COPCs and PRC mentoring to address community and COPC dynamics. Conclusion Stakeholder engagement in an iterative HCD process has been integral to co-designing a PRC role that multiple stakeholder groups consider acceptable and that COPC teams are willing to implement. This offers a methodological framework for other teams designing SU workforce innovations.
Collapse
Affiliation(s)
| | | | - Kim Johnson
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Imani Brown
- Department of Psychology, University of Maryland
| | | | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | - Yuche Jacobs
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council
| | | | | | - Dwayne Dean
- Department of Psychology, University of Maryland
| | | | - Jessica Magidson
- Center for Substance Use, Addiction & Health Research, University of Maryland
| |
Collapse
|
2
|
Safren SA, Lee JS, Andersen LS, Stanton AM, Kagee A, Kirakosian N, O'Cleirigh C, Joska JA. The salience of structural barriers and behavioral health problems to ART adherence in people receiving HIV primary care in South Africa. AIDS Care 2024; 36:154-160. [PMID: 38359349 PMCID: PMC11283988 DOI: 10.1080/09540121.2024.2308750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
Multilevel factors (individual and structural) influence adherence to antiretroviral therapy, particularly in high HIV prevalence areas such as South Africa. The present study examined the relative importance of structural barriers to HIV care and behavioral health factors, depression and alcohol use, in Khayelitsha, Cape Town, South Africa. People receiving HIV care in six primary care clinics in Khayelitsha (N = 194) completed the Center for Epidemiologic Studies Depression Scale, the Alcohol Use Disorders Identification Test, the Structural Barriers to Medication Taking questionnaire, and a qualitative rating of past-two-week adherence. Correlations were employed to examine associations among these variables, and hierarchical regression analysis was used to examine the unique effects of structural barriers over and above depression and alcohol use as predictors of adherence. Participants were primarily Black South African (99%) women (83%), and 41 years old on average. All four variables were significantly correlated. The hierarchical regression analysis showed that among behavioral health predictors, alcohol use alone significantly predicted ART adherence (b = -.032, p = .002). When structural barriers was added to the model, it was the only significant unique predictor of ART adherence (b = -1.58, p < .001). Findings highlight the need to consider structural vulnerabilities in HIV care in South Africa when developing behavioral health interventions.
Collapse
Affiliation(s)
- Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Kagee A, Saal W, Sterley A. Utility of the Alcohol Use Disorder Inventory Test in determining caseness for alcohol use disorder among persons receiving antiretroviral therapy. AIDS Care 2024:1-6. [PMID: 38870006 DOI: 10.1080/09540121.2024.2365853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
We sought to determine the utility of the Alcohol Use Disorder Identification Test (AUDIT) in screening for alcohol use disorder (AUD) among 688 users of antiretroviral therapy (ART). We used the receiver operating characteristic (ROC) curve analysis to assess whether the AUDIT reliably detected AUD against the Structured Clinical Interview for the DSM (SCID). Of the samples, 22.09% (CI: 19.05% to 25.38%) of participants met the diagnostic criteria for AUD. Among men (n = 135) and women (n = 553), the prevalence estimates were 31.9% and 19.7%, respectively. For men, a cut-off score of 6 predicted AUD with 88.36% (95%CI: 74.92-96.11) sensitivity and 88.04% (95%CI: 79.61-93.88) specificity. For women, a cut-off score of 4 on the AUDIT yielded an optimal sensitivity of 92.66% (95% CI: 86.05%-96.78%) and a specificity of 93.24% (95% CI: 90.49-95.40%). For men, the AUDIT yielded a positive predictive value (PPV) of 75.55% (95% CI: 66.26%-85.87%) and a negative predictive value (NPV) of 91.49% (95% CI: 87.63-97.37%); for women the PPV and NPV were 77.09% (70.34%-82.68%) and 98.11% (96.37%-99.02%), respectively. The instrument's good sensitivity and specificity indicate it is likely to be useful for screening and referral of ART users who are probably cases of AUD.
Collapse
Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Wylene Saal
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Adelle Sterley
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
4
|
Ayieko P, Kisanga E, Mshana G, Nkosi S, Hansen CH, Parry CDH, Weiss HA, Grosskurth H, Hayes RJ, Morojele NK, Kapiga S. Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management. AIDS Care 2024; 36:652-660. [PMID: 38295268 DOI: 10.1080/09540121.2023.2299324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%-15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10-7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92-9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence.
Collapse
Affiliation(s)
- Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Sebenzile Nkosi
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Neo K Morojele
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Medical Research, Mwanza, Tanzania
| |
Collapse
|
5
|
Hines AC, Rose AL, Regenauer KS, Brown I, Johnson K, Bonumwezi J, Ndamase S, Ciya N, Magidson JF, Myers B. " Early in the morning, there's tolerance and later in the day it disappears" - The intersection of resource scarcity, stress and stigma in mental health and substance use care in South Africa. Glob Ment Health (Camb) 2024; 11:e45. [PMID: 38690575 PMCID: PMC11058524 DOI: 10.1017/gmh.2024.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
Stress is a challenge among non-specialist health workers worldwide, particularly in low-resource settings. Understanding and targeting stress is critical for supporting non-specialists and their patients, as stress negatively affects patient care. Further, stigma toward mental health and substance use conditions also impacts patient care. However, there is little information on the intersection of these factors. This sub-analysis aims to explore how substance use and mental health stigma intersect with provider stress and resource constraints to influence the care of people with HIV/TB. We conducted semi-structured interviews (N=30) with patients (n=15) and providers (n=15, non-specialist health workers) within a low-resource community in Cape Town, South Africa. Data were analyzed using thematic analysis. Three key themes were identified: (1) resource constraints negatively affect patient care and contribute to non-specialist stress; (2) in the context of stress, non-specialists are hesitant to work with patients with mental health or substance use concerns, who they view as more demanding and (3) stress contributes to provider stigma, which negatively impacts patient care. Findings highlight the need for multilevel interventions targeting both provider stress and stigma toward people with mental health and substance use concerns, especially within the context of non-specialist-delivered mental health services in low-resource settings.
Collapse
Affiliation(s)
- Abigail C. Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Imani Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Kim Johnson
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jessica Bonumwezi
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Sibabalwe Ndamase
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Nonceba Ciya
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use, Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Lee JS, Bainter SA, Tsai AC, Andersen LS, Stanton AM, Magidson JF, Kagee A, Joska JA, O'Cleirigh C, Safren SA. Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems. AIDS Behav 2023; 27:1741-1756. [PMID: 36309936 PMCID: PMC10148921 DOI: 10.1007/s10461-022-03906-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/27/2022]
Abstract
In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.
Collapse
Affiliation(s)
- Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
7
|
Mpinganjira MG, Chirwa T, Kabudula CW, Gómez-Olivé FX, Tollman S, Francis JM. Association of alcohol use and multimorbidity among adults aged 40 years and above in rural South Africa. Sci Rep 2023; 13:7807. [PMID: 37183234 PMCID: PMC10183457 DOI: 10.1038/s41598-023-35018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023] Open
Abstract
We assessed the prevalence of reported alcohol use and its association with multimorbidity among adults aged 40 years and above in a rural, transitioning South African setting. Findings could potentially inform alcohol interventions integration in the prevention and treatment of chronic conditions. We analysed data from the first wave of The Health and Ageing in Africa-a longitudinal Study in an INDEPTH community (HAALSI) nested within the Agincourt Health and Demographic Surveillance Systems, conducted between November 2014 and November 2015 (n = 5059). We computed descriptive statistics and performed univariate analysis to determine factors independently associated with multimorbidity. Age, Body Mass Index, education, sex, and household wealth status and variables with a p-value < 0.20 in univariate analysis were included in multivariable Modified Poisson regression models. Any factors with a p-value of < 0.05 in the final models were considered statistically significant. The first wave of HAALSI was completed by 5059 participants aged 40 years and above and included 2714 (53.6%) females. The prevalence of reported ever alcohol use was 44.6% (n = 2253) and of these 51.9% (n = 1171) reported alcohol use in the last 30 days. The prevalence of HIV multimorbidity was 59.6% (3014/5059) and for multimorbidity without HIV 52.5% (2657/5059). Alcohol use was associated with HIV multimorbidity among all participants (RR: 1.05, 95% CI: 1.02-1.08), and separately for males (RR: 1.05, 95% CI: 1.00-1.10) and females (RR: 1.06, 95%CI: 1.02-1.11). Similarly, alcohol use was associated with multimorbidity without HIV among all participants (RR: 1.05, 95% CI: 1.02-1.09), and separately for males (RR: 1.06, 95% CI: 1.00-1.12) and females (RR: 1.06, 95% CI: 1.01-1.11). Reported alcohol use was common and associated with HIV multimorbidity and multimorbidity without HIV among older adults in rural northeast South Africa. There is a need to integrate Screening, Brief Interventions, and Referral for alcohol Treatment in the existing prevention and treatment of multimorbidity in South Africa.
Collapse
Affiliation(s)
- Mafuno G Mpinganjira
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
8
|
Mushi D, Hanlon C, Francis JM, Candida M, Demissie M, Teferra S. Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania. BMC PRIMARY CARE 2023; 24:106. [PMID: 37085751 PMCID: PMC10120272 DOI: 10.1186/s12875-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels. METHODS A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC. RESULTS A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored. CONCLUSIONS The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
Collapse
Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, P.O Box 65001, United Nations Road, Dar Es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Moshiro Candida
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Psychiatric Nursing Department, School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia, Dire Dawa , Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
9
|
Muyindike WR, Fatch R, Cheng DM, Emenyonu NI, Forman L, Ngabirano C, Adong J, Linas B, Jacobson KR, Hahn JA. Unhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda. J Acquir Immune Defic Syndr 2022; 91:460-468. [PMID: 36044285 PMCID: PMC9649866 DOI: 10.1097/qai.0000000000003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known. METHODS This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as <90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1-2 (women) or 1-3 (men) and/or PEth 8 ≥ 50 ng/mL; and unhealthy: AUDIT-C ≥3 (women) or ≥4 (men) and/or PEth ≥50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence. RESULTS Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption. CONCLUSIONS Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB.
Collapse
Affiliation(s)
- Winnie R Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Robin Fatch
- University of California, San Francisco, San Francisco, CA
| | - Debbie M Cheng
- Boston University School of Public Health, Boston, MA; and
| | | | - Leah Forman
- Boston University School of Public Health, Boston, MA; and
| | | | - Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Judith A Hahn
- University of California, San Francisco, San Francisco, CA
| |
Collapse
|
10
|
Magidson JF, Rose AL, Regenauer KS, Brooke-Sumner C, Anvari MS, Jack HE, Johnson K, Belus JM, Joska J, Bassett IV, Sibeko G, Myers B. "It's all about asking from those who have walked the path": Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa. Addict Sci Clin Pract 2022; 17:52. [PMID: 36131304 PMCID: PMC9490994 DOI: 10.1186/s13722-022-00330-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers-individuals with lived experience of SUD-may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. METHODS Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. RESULTS On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. CONCLUSIONS Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Kristen S Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Morgan S Anvari
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa
| | - Jennifer M Belus
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Goodman Sibeko
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa.
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, WA, 6845, Australia.
| |
Collapse
|
11
|
Rose AL, Belus JM, Hines AC, Barrie I, Regenauer KS, Andersen LS, Joska JA, Ciya N, Ndamase S, Myers B, Safren SA, Magidson JF. Patient and provider perceptions of a peer-delivered intervention (' Khanya') to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis. Glob Ment Health (Camb) 2022; 9:439-447. [PMID: 36618732 PMCID: PMC9807005 DOI: 10.1017/gmh.2022.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
Background Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Methods Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence 'Life-Steps', behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Results Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Conclusions Findings underscore the importance of examining patients' perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within task-shared behavioral interventions in low- and middle-income countries.
Collapse
Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Jennifer M. Belus
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Abigail C. Hines
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Issmatu Barrie
- Department of Psychology, University of Maryland, College Park, MD, USA
- Westat, Rockville, MD, USA
| | | | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Nonceba Ciya
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
| | - Sibabalwe Ndamase
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
| | - Bronwyn Myers
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Australia
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | |
Collapse
|
12
|
Belus JM, Joska JA, Bronsteyn Y, Rose AL, Andersen LS, Regenauer KS, Myers B, Hahn JA, Orrell C, Safren SA, Magidson JF. Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa. AIDS Behav 2022; 26:3630-3641. [PMID: 35895150 PMCID: PMC9550692 DOI: 10.1007/s10461-022-03765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/21/2022]
Abstract
Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD. Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
Collapse
Affiliation(s)
- Jennifer M Belus
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Psychology, University of Maryland, College Park, MD, USA.
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Yosef Bronsteyn
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | | |
Collapse
|
13
|
Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:50. [PMID: 35794580 PMCID: PMC9258127 DOI: 10.1186/s13011-022-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. DESIGN A cross-sectional survey SETTING: Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. PARTICIPANTS A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants' records were reviewed to assess the screening and management of AUD. RESULTS In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). CONCLUSION While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.
Collapse
Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa) College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics Muhimbili, University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Epidemiology and Biostatistics Muhimbili, University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
14
|
Belus JM, Rose AL, Andersen LS, Ciya N, Joska JA, Myers B, Safren SA, Magidson JF. Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:454-467. [PMID: 36171964 PMCID: PMC9512118 DOI: 10.1016/j.cbpra.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed "Khanya" in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills. Trial registration ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
Collapse
Affiliation(s)
| | | | | | | | | | - Bronwyn Myers
- South African Medical Research Council, University of Cape Town
| | | | | |
Collapse
|
15
|
Ipser JC, Joska J, Sevenoaks T, Gouse H, Freeman C, Kaufmann T, Andreassen OA, Shoptaw S, Stein DJ. Limited evidence for a moderating effect of HIV status on brain age in heavy episodic drinkers. J Neurovirol 2022; 28:383-391. [PMID: 35355213 DOI: 10.1007/s13365-022-01072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
Abstract
We set out to test the hypothesis that greater brain ageing will be observed in people with HIV (PWH) and those who engage in heavy episodic drinking (HED), with their combined effects being especially detrimental in cognitive control brain networks. We correlated measures of "brain age gap" (BAG) and neurocognitive impairment in participants with and without HIV and HED. Sixty-nine participants were recruited from a community health centre in Cape Town: HIV - /HED - (N = 17), HIV + /HED - (N = 14), HIV - /HED + (N = 21), and HIV + /HED + (N = 17). Brain age was modelled using structural MRI features from the whole brain or one of six brain regions. Linear regression models were employed to identify differences in BAG between patient groups and controls. Associations between BAG and clinical data were tested using bivariate statistical methods. Compared to controls, greater global BAG was observed in heavy drinkers, both with (Cohen's d = 1.52) and without (d = 1.61) HIV. Differences in BAG between HED participants and controls were observed for the cingulate and parietal cortex, as well as subcortically. A larger BAG was associated with higher total drinking scores but not nadir CD4 count or current HIV viral load. The association between heavy episodic drinking and BAG, independent of HIV status, points to the importance of screening for alcohol use disorders in primary care. The relatively large contribution of cognitive control brain regions to BAG highlights the utility of assessing the contribution of different brain regions to brain age.
Collapse
Affiliation(s)
- Jonathan C Ipser
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa. .,Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - John Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Tatum Sevenoaks
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Carla Freeman
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Tobias Kaufmann
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT Oslo University Hospital & University of Oslo, Tübingen, Germany.,Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Institute of Clinical Medicine, NORMENT Oslo University Hospital & University of Oslo, Tübingen, Germany
| | - Steve Shoptaw
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa.,MRC Unit On Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
16
|
Belus JM, Regenauer KS, Hutman E, Rose AL, Burnhams W, Andersen LS, Myers B, Joska JA, Magidson JF. Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100035. [PMID: 36845899 PMCID: PMC9948858 DOI: 10.1016/j.dadr.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/15/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
Introduction Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Methods Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). Results None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients' needs or interest in receiving an SU referral. Discussion SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.
Collapse
Affiliation(s)
- Jennifer M. Belus
- Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland,University of Maryland, Department of Psychology, College Park, MD, USA,Corresponding author at: Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4051, Switzerland.
| | | | - Elizabeth Hutman
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Warren Burnhams
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - Lena S. Andersen
- University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa,University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | | |
Collapse
|
17
|
Peprah E, Myers B, Kengne AP, Peer N, El-Shahawy O, Ojo T, Mukasa B, Ezechi O, Iwelunmor J, Ryan N, Sakho F, Patena J, Gyamfi J. Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1097. [PMID: 35162121 PMCID: PMC8834153 DOI: 10.3390/ijerph19031097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
Substance use is increasing throughout Africa, with the prevalence of alcohol, tobacco, cannabis, and other substance use varying regionally. Concurrently, sub-Saharan Africa bears the world's largest HIV burden, with 71% of people living with HIV (PWH) living in Africa. Problematic alcohol, tobacco, and other substance use among PWH is associated with multiple vulnerabilities comprising complex behavioral, physiological, and psychological pathways that include high-risk behaviors (e.g., sexual risk-taking), HIV disease progression, and mental health problems, all of which contribute to nonadherence to antiretroviral therapy. Physiologically, severe substance use disorders are associated with increased levels of biological markers of inflammation; these, in turn, are linked to increased mortality among PWH. The biological mechanisms that underlie the increased risk of substance use among PWH remain unclear. Moreover, the biobehavioral mechanisms by which substance use contributes to adverse health outcomes are understudied in low- and middle-income countries (LMIC). Syndemic approaches to understanding the co-occurrence of substance use and HIV have largely been limited to high-income countries. We propose a syndemic coupling conceptual model to disentangle substance use from vulnerabilities to elucidate underlying disease risk for PWH. This interventionist perspective enables assessment of biobehavioral mechanisms and identifies malleable targets of intervention.
Collapse
Affiliation(s)
- Emmanuel Peprah
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; (A.-P.K.); (N.P.)
| | - Omar El-Shahawy
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD 21287, USA
| | - Temitope Ojo
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Yaba, Lagos 101245, Nigeria;
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO 63104, USA;
| | - Nessa Ryan
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Fatoumata Sakho
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - John Patena
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| | - Joyce Gyamfi
- Global Health Program, New York University School of Global Public Health, New York, NY 10003, USA; (O.E.-S.); (T.O.); (N.R.); (F.S.); (J.P.); (J.G.)
| |
Collapse
|
18
|
Mushi D, Francis JM, Moshiro C, Hanlon C, Teferra S. Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review. Front Psychiatry 2022; 13:822791. [PMID: 35370845 PMCID: PMC8964495 DOI: 10.3389/fpsyt.2022.822791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa. Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap. Integrating services for mental, neurological, and substance use disorders in general health care settings is among the recommended strategies to narrow this treatment gap. This scoping review aimed to map the available evidence on integration of AUD interventions in general health care settings in sub-Saharan Africa. METHODS We searched four databases (PubMed, PsycINFO, CINAHL, and Africa Wide Information) for publications up to December 2020. The search strategy focused on terms for alcohol use, alcohol interventions, and sub-Saharan African countries. Studies that reported AUD interventions in general health care settings in sub-Saharan Africa were eligible for inclusion. Over 3,817 potentially eligible articles were identified. After the removal of duplicates and screening of abstracts, 56 articles were included for full article review. Of these, 24 papers reporting on 22 studies were eligible and included in a narrative review. RESULTS Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities, and 2 (8%) studies reported on AUD interventions integrated into general health care settings. CONCLUSIONS This review shows that there is limited evidence on the integration of AUD interventions in health care settings in sub-Saharan Africa. There is an urgent need for studies that report systematically on the development, adaptation, implementation, and evaluation of integrated AUD interventions in health care settings in sub-Saharan Africa.
Collapse
Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, Witwatersrand University, Johannesburg, South Africa.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Service and Population Research Department and WHO Collaborating Centre for Mental Health and Training, Institute of Psychiatry, Psychology, and Neuroscience, King's College University, London, United Kingdom
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
19
|
Spies G, Ahmed-Leitao F, Hoddinott G, Seedat S. Effects of unhealthy alcohol use on brain morphometry and neurocognitive function among people with HIV. J Neurovirol 2021; 28:35-45. [PMID: 34882280 DOI: 10.1007/s13365-021-01027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/13/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Individual impacts of alcohol misuse and HIV on brain structure and function have been well demonstrated; however, the potential compounded effect of these conditions is seldom considered, despite the high prevalence of alcohol use in HIV infection. We aimed to determine the effects of unhealthy alcohol use on brain morphometry and cognitive function amongst people with HIV (PWH). In 27 (50.9%) HIV-positive users of alcohol and 26 (49.1%) HIV-positive abstainers from alcohol, results revealed significant differences for left and right amygdala (p < 0.01), left and right hippocampus (p = 0.05), left and right posterior cingulate (p < 0.01), left and right precuneus (p < 0.01), left insula (p < 0.01), left and right caudate (p < 0.01), right thalamus (p < 0.01), and corpus callosum (p < 0.05). Mean volume of these regions was significantly smaller in HIV-positive alcohol users compared to HIV-positive abstainers. Homogeneity of slopes ANCOVA revealed significant associations between anterior cingulate cortex, precuneus, amygdala, hippocampus, and insula volumes and cognitive function in the domains of learning and delayed recall, motor function, speed of information processing, executive function, attention/working memory, and language. Among PWH, unhealthy alcohol use is associated with negative effects on brain structure and cognitive function.
Collapse
Affiliation(s)
- Georgina Spies
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Fatima Ahmed-Leitao
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry, South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| |
Collapse
|
20
|
Wechsberg WM, Browne FA, Ndirangu J, Bonner CP, Kline TL, Gichane M, Zule WA. Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa. AIDS Behav 2021; 25:276-289. [PMID: 33891233 PMCID: PMC8063777 DOI: 10.1007/s10461-021-03251-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/05/2023]
Abstract
Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country’s 90-90-90 targets. The Women’s Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.
Collapse
|
21
|
Myers B, Lombard C, Joska JA, Abdullah F, Naledi T, Lund C, Petersen Williams P, Stein DJ, Sorsdahl KR. Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa. AIDS Behav 2021; 25:3758-3769. [PMID: 33876383 PMCID: PMC8560660 DOI: 10.1007/s10461-021-03263-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.
Collapse
Affiliation(s)
- B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa.
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - F Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - T Naledi
- Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C Lund
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - P Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - D J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council's Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - K R Sorsdahl
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
22
|
Chichetto NE, Kundu S, Freiberg MS, Koethe JR, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Justice AC, Fiellin DA, Khan M, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner A, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection. AIDS Behav 2021; 25:2852-2862. [PMID: 34101074 PMCID: PMC8376776 DOI: 10.1007/s10461-021-03327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.
Collapse
Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA.
| | - Suman Kundu
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Weill-Cornell Medical College, Doha, USA
- Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Health Care Policy, and Aging Research and School of Social Work, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Maria Khan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie R Gaither
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Shirish S Barve
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberta Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
23
|
Nguyen MX, McNaughton Reyes HL, Pence BW, Muessig K, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Ha Tran V, Go VF. The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam. J Int AIDS Soc 2021; 24 Suppl 2:e25746. [PMID: 34165258 PMCID: PMC8222856 DOI: 10.1002/jia2.25746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association. METHODS This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time-lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation. RESULTS The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. CONCLUSIONS Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.
Collapse
Affiliation(s)
- Minh X Nguyen
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - H. Luz McNaughton Reyes
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Brian W Pence
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kate Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Carl A Latkin
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Kathryn E Lancaster
- Department of EpidemiologyCollege of Public HealthOhio State UniversityColumbusOHUSA
| | - Constantine Frangakis
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Teerada Sripaipan
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Viet Ha Tran
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Vivian F Go
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| |
Collapse
|
24
|
Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, Myers B, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc 2021; 24 Suppl 2:e25720. [PMID: 34164935 PMCID: PMC8222840 DOI: 10.1002/jia2.25720] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low-resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. METHODS A pilot randomized hybrid type 1 effectiveness-implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task-shared, peer-delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on-site AOD treatment. Implementation outcomes, defined by Proctor's model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post-treatment (three months) measured via real-time electronic adherence monitoring, and AOD measured using biomarker and self-report assessments over six months. Data collection was conducted from August 2018 to April 2020. RESULTS AND DISCUSSION Ninety-one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment-by-time interaction for ART adherence (estimate = -0.287 [95% CI = -0.507, -0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self-reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow-back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). CONCLUSIONS Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non-adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task-sharing models for behavioral health in resource-limited, global settings.
Collapse
Affiliation(s)
| | - John A Joska
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | - Lena S Andersen
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilDivision of Addiction PsychiatryDepartment of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Sybil Majokweni
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | - Conall O’Cleirigh
- Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | |
Collapse
|
25
|
New-Aaron M, Ganesan M, Dagur RS, Kharbanda KK, Poluektova LY, Osna NA. Pancreatogenic Diabetes: Triggering Effects of Alcohol and HIV. BIOLOGY 2021; 10:108. [PMID: 33546230 PMCID: PMC7913335 DOI: 10.3390/biology10020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
Multiorgan failure may not be completely resolved among people living with HIV despite HAART use. Although the chances of organ dysfunction may be relatively low, alcohol may potentiate HIV-induced toxic effects in the organs of alcohol-abusing, HIV-infected individuals. The pancreas is one of the most implicated organs, which is manifested as diabetes mellitus or pancreatic cancer. Both alcohol and HIV may trigger pancreatitis, but the combined effects have not been explored. The aim of this review is to explore the literature for understanding the mechanisms of HIV and alcohol-induced pancreatotoxicity. We found that while premature alcohol-inducing zymogen activation is a known trigger of alcoholic pancreatitis, HIV entry through C-C chemokine receptor type 5(CCR5)into pancreatic acinar cells may also contribute to pancreatitis in people living with HIV (PLWH). HIV proteins induce oxidative and ER stresses, causing necrosis. Furthermore, infiltrative immune cells induce necrosis on HIV-containing acinar cells. When necrotic products interact with pancreatic stellate cells, they become activated, leading to the release of both inflammatory and profibrotic cytokines and resulting in pancreatitis. Effective therapeutic strategies should block CCR5 and ameliorate alcohol's effects on acinar cells.
Collapse
Affiliation(s)
- Moses New-Aaron
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
| | - Murali Ganesan
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Raghubendra Singh Dagur
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kusum K. Kharbanda
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Larisa Y. Poluektova
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Natalia A. Osna
- Department of Environmental Health, Occupational Health and Toxicology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Veteran Affairs Nebraska—Western Iowa Health Care System, Omaha, NE 68105, USA; (M.G.); (R.S.D.); (K.K.K.)
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| |
Collapse
|
26
|
"Moving Forward with Life": Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165706. [PMID: 32784613 PMCID: PMC7459709 DOI: 10.3390/ijerph17165706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.
Collapse
|
27
|
Muyindike WR, Fatch R, Cheng DM, Emenyonu NI, Ngabirano C, Adong J, Linas BP, Jacobson KR, Hahn JA. Tuberculin skin test positivity among HIV-infected alcohol drinkers on antiretrovirals in south-western Uganda. PLoS One 2020; 15:e0235261. [PMID: 32614873 PMCID: PMC7332058 DOI: 10.1371/journal.pone.0235261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH), and current evidence suggests that heavy alcohol users have an increased risk of developing TB disease compared to non-drinkers. Not known is whether the increased risk for TB disease among alcohol users may reflect higher rates of latent TB infection (LTBI) among this population. We assessed the latent TB infection prevalence based on tuberculin skin testing (TST) and examined association with current alcohol use among HIV-infected persons on antiretroviral therapy (ART) in south-western Uganda. METHODS We included PLWH at the Mbarara Regional Hospital HIV clinic, who were either current alcohol consumers (prior 3 months) or past year abstainers (2:1 enrolment ratio). Participants were recruited for a study of isoniazid preventive therapy for LTBI. TST was performed using 5 tuberculin units of purified protein derivative. The primary outcome was a positive TST reading (≥5mm induration), reflecting LTBI. We used logistic regression analyses to assess the cross-sectional association between self-reported current alcohol use and a positive TST. RESULTS Of the 295 of 312 (95%) who returned for TST reading, 63% were females and 63% were current alcohol drinkers. The TST positive prevalence was 27.5% (95% confidence interval [CI]: 22.6% - 32.9%). The odds of a positive TST for current alcohol users compared to abstainers was 0.76 (95% CI: 0.41, 1.41), controlling for gender, age, body mass index, history of smoking, and prior unhealthy alcohol use. CONCLUSIONS The prevalence of LTBI among PLWH on ART in south-western Uganda was moderate and LTBI poses a risk for future infectious TB. Although alcohol use is common, we did not detect an association between current drinking or prior unhealthy alcohol use and LTBI. Further studies to evaluate the association between LTBI and different levels of current drinking (heavy versus not) are needed.
Collapse
Affiliation(s)
- Winnie R. Muyindike
- Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Debbie M. Cheng
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Nneka I. Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Christine Ngabirano
- Grants Office, Directorate of Research and Post graduate Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Department of Paediatrics, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Karen R. Jacobson
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
28
|
Gender Differences in the Utility of the Alcohol Use Disorder Identification Test in Screening for Alcohol Use Disorder Among HIV Test Seekers in South Africa. AIDS Behav 2020; 24:2073-2081. [PMID: 31919618 DOI: 10.1007/s10461-019-02772-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We evaluated the effectiveness of the Alcohol Use Disorder Identification Test (AUDIT) in screening for alcohol use disorder (AUD) among 500 men and women seeking HIV testing. Receiver operating characteristic (ROC) curve analysis was used to determine the utility of the AUDIT in discriminating between AUD caseness and non-caseness. For men, a cut-off score of 10 on the AUDIT predicted AUD with 81% sensitivity and 77% specificity. For women, a cut-off score of 7 yielded optimal sensitivity (82%) and specificity (82%). For men, the AUDIT yielded a positive predictive value (PPV) of 49% and a negative predictive value (NPV) of 94%; for women the PPV and NPV were 49 and 96%, respectively. While the AUDIT can be used to rapidly screen large numbers of men and women seeking HIV testing, the instrument's low PPV indicates that individuals who screen positive may need to undergo further evaluation to detect cases of AUD.
Collapse
|
29
|
Petersen Williams P, Brooke-Sumner C, Joska J, Kruger J, Vanleeuw L, Dada S, Sorsdahl K, Myers B. Young South African Women on Antiretroviral Therapy Perceptions of a Psychological Counselling Program to Reduce Heavy Drinking and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2249. [PMID: 32230712 PMCID: PMC7178219 DOI: 10.3390/ijerph17072249] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 01/06/2023]
Abstract
Young women in South Africa remain most at risk for HIV infection. Several factors contribute to the high incidence rate in this population, including hazardous drinking and depression. Addressing common mental disorders (CMDs) such as depression and alcohol use disorders is key to effective HIV treatment. We explored the experiences and perceptions of young South African women on antiretroviral therapy (ART) of a lay health worker (LHW)-delivered psychosocial intervention based on motivational interviewing (MI) and problem-solving therapy (PST) to reduce heavy drinking and depression. We conducted 27 in-depth interviews with young women (aged 18-35) recruited from 16 primary care clinics in the Western Cape province of South Africa. Discussion topics included young women's life experiences leading to their enrollment in the program, their perceptions of the counselling sessions and the quality of their interaction with the counsellor. Qualitative data were analyzed using a framework approach. The findings highlighted the impact adverse life experiences and stressful life circumstances have on young women's use of alcohol and symptoms of depression and the effect this has on ART adherence. The findings suggest that women found the intervention components that helped them develop strategies for coping with their past experiences, managing current life stressors, and regulating negative thoughts and emotions most beneficial. Taken together, these findings confirm the acceptability of LHW-delivered MI-PST counselling for this population, but suggest that the relevance of the MI-PST intervention for this highly vulnerable population could be further enhanced by including a focus on psychological trauma.
Collapse
Affiliation(s)
- Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - John Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - James Kruger
- Western Cape Department of Health., 8 Riebeeck Street, Cape Town 8000, South Africa;
| | - Lieve Vanleeuw
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa;
| | - Siphokazi Dada
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa;
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg 7505, South Africa; (C.B.-S.); (S.D.); (B.M.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa
| |
Collapse
|
30
|
Magidson JF, Joska JA, Myers B, Belus JM, Regenauer KS, Andersen LS, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa. Implement Sci Commun 2020; 1:23. [PMID: 32607502 PMCID: PMC7326344 DOI: 10.1186/s43058-020-00004-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population. METHODS Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one's environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor's model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patient-level effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome. DISCUSSION Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
Collapse
Affiliation(s)
- Jessica F. Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Kristen S. Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD USA
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sybil Majokweni
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, USA
| |
Collapse
|
31
|
Associations between alcohol use and HIV care cascade outcomes among adults undergoing population-based HIV testing in East Africa. AIDS 2020; 34:405-413. [PMID: 31725431 DOI: 10.1097/qad.0000000000002427] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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.
Collapse
|
32
|
Magidson JF, Andersen LS, Satinsky EN, Myers B, Kagee A, Anvari M, Joska JA. "Too much boredom isn't a good thing": Adapting behavioral activation for substance use in a resource-limited South African HIV care setting. Psychotherapy (Chic) 2020; 57:107-118. [PMID: 31670529 PMCID: PMC7069775 DOI: 10.1037/pst0000257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Lena S. Andersen
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South
African Medical Research Council; Division of Addiction Psychiatry, Department of
Psychiatry and Mental Health, University of Cape Town
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University
| | - Morgan Anvari
- Department of Psychology, University of Maryland, College
Park
| | - John A. Joska
- HIV Mental Health Research Unit, Division of
Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape
Town
| |
Collapse
|
33
|
Magidson JF, Joska JA, Regenauer KS, Satinsky E, Andersen LS, Seitz-Brown CJ, Borba CPC, Safren SA, Myers B. "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:61-69. [PMID: 31082664 PMCID: PMC6679990 DOI: 10.1016/j.drugpo.2018.11.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022]
Abstract
South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.
Collapse
Affiliation(s)
- Jessica F Magidson
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Anzio Road, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa.
| | | | - Emily Satinsky
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - Lena S Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Anzio Road, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa.
| | - C J Seitz-Brown
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - Christina P C Borba
- Boston University/Boston Medical Center, 85 E. Newton St., Fuller Building, Boston, MA, USA.
| | - Steven A Safren
- University of Miami, Clinical Research Building, Miller School of Medicine, 1120 NW 14th St., Suite, 787, Miami, FL, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council Francie Van Zyl Drive, Parow, 7505, South Africa; Division of Addiction Psychiatry, Department of Psychiatry, and Mental Health, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
34
|
Addressing unhealthy alcohol use among people living with HIV: recent advances and research directions. Curr Opin Infect Dis 2019; 31:1-7. [PMID: 29176446 DOI: 10.1097/qco.0000000000000422] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Unhealthy alcohol use is prevalent among people living with HIV (PLWH). We sought to identify the most current literature examining the impact of unhealthy alcohol on health outcomes and latest developments on how to best intervene. RECENT FINDINGS New research shows that PLWH have heightened morbidity and mortality at lower levels of alcohol consumption compared with HIV-uninfected persons. Studies published since 2016 have further elucidated the effects of persistent unhealthy alcohol use on HIV treatment outcomes over time. Screening and brief interventions, as well as pharmacologic treatment, can reduce unhealthy alcohol use among PLWH. SUMMARY Unhealthy alcohol use is an important and modifiable risk factor for poor health and HIV treatment outcomes among PLWH. More research is needed to encourage and maintain engagement in alcohol-related interventions and improve implementation.
Collapse
|
35
|
Magidson JF, Fatch R, Orrell C, Amanyire G, Haberer JE, Hahn JA. Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa. AIDS Behav 2019; 23:1656-1667. [PMID: 30560484 PMCID: PMC6535416 DOI: 10.1007/s10461-018-2364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Individuals are initiating antiretroviral therapy (ART) at earlier HIV disease stages. Unhealthy alcohol use is a known barrier to successful HIV treatment outcomes, yet it is unclear whether the problem varies by disease stage. We measured alcohol use with an objective biomarker (phosphatidylethanol [PEth]), comparing individuals (n = 401) with early (CD4 > 350 cells/mL, WHO Stage 1) versus late (CD4 < 200 cells/mL) ART initiation in HIV care in Uganda and South Africa (SA). We examined the association between CD4 count and biomarker results using multivariable regression modeling, and compared PEth results to self-report to assess underreporting. Overall, 32.2% (n = 129) had unhealthy alcohol use (PEth ≥ 50 ng/ml). Early ART initiation was significantly associated with unhealthy alcohol use in Uganda (AOR 2.65; 95% CI: 1.05–6.72), but not SA (AOR 1.00; 95% CI: 0.46–2.17). In Uganda, 23.2% underreported unhealthy alcohol use versus 11.6% in SA (χ2 = 9.30; p < 0.01). Addressing unhealthy alcohol use is important as patients initiate ART earlier, yet challenging due to underreporting.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 1147B Biology-Psychology, College Park, MD, 20742, USA.
| | - Robin Fatch
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Department of Medicine and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
36
|
Magidson JF, Iyer HS, Regenauer KS, Grelotti DJ, Dietrich JJ, Courtney I, Tshabalala G, Orrell C, Gray GE, Bangsberg DR, Katz IT. Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression. Drug Alcohol Depend 2019; 198:192-198. [PMID: 30953938 PMCID: PMC6644059 DOI: 10.1016/j.drugalcdep.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally. METHODS Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use). RESULTS Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02). CONCLUSIONS Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression.
Collapse
Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, 4095 Campus Drive, College Park, MD, USA.
| | - Hari S Iyer
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Kristen S Regenauer
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA.
| | - David J Grelotti
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Ingrid Courtney
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Gugu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Catherine Orrell
- Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa.
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Office of the President, South African Medical Research Council, Western Cape, ZA, South Africa.
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
37
|
Is Alcohol Use Associated With Increased Risk of Developing Adverse Health Outcomes Among Adults Living With Human Immunodeficiency Virus: A Systematic Review. J Addict Nurs 2018; 29:96-118. [PMID: 29864058 DOI: 10.1097/jan.0000000000000220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol use is associated with many HIV-related behaviors that are associated with increased risk of reinfection, transmission, and poorer health outcomes in people living with HIV (PLHIV). The population of middle-aged and older PLHIV is growing because of increased life longevity and aging trend. METHODS A systematic review across three databases was conducted to evaluate existing studies that examined the association between alcohol use and medication adherence, high-risk sex behaviors, HIV progression, depression, resource utilization, and survival among studies of PLHIV with an average age of 40 years and above. RESULTS Among the 47 included studies, most found a positive association between alcohol use and depression, risky sex behaviors, medication nonadherence, and healthcare resource utilization among PLHIV. The association between alcohol use and response to treatment was variable. The association between alcohol use and survival warrants further study because of lack of existing studies. CONCLUSIONS The results of this review support that alcohol use negatively impacts middle-aged and older PLHIV in many aspects; however, there is lack of studies exclusively targeting older PLHIV, and more relevant studies in the future are needed.
Collapse
|
38
|
Mohr E, Snyman L, Mbakaz Z, Caldwell J, DeAzevedo V, Kock Y, Trivino Duran L, Venables E. "Life continues": Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa. PLoS One 2018; 13:e0203888. [PMID: 30216368 PMCID: PMC6138394 DOI: 10.1371/journal.pone.0203888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background Self-administered treatment (SAT), a differentiated model of care for rifampicin-resistant tuberculosis (RR-TB), might address adherence challenges faced by patients and health care systems. This study explored patient, health-care worker (HCW) and community care worker (CCW) perspectives on a SAT pilot programme in South Africa, in which patients were given medication to take at home with the optional support of a CCW. Methods We conducted a mixed-methods study from July 2016-June 2017. The quantitative component included semi-structured questionnaires with patients, HCWs and CCWs; the qualitative component involved in-depth interviews with patients enrolled in the pilot programme. Interviews were conducted in isiXhosa, translated, transcribed and manually coded. Results Overall, 27 patients, 12 HCWs and 44 CCWs were enrolled in the quantitative component; nine patients were also interviewed. Of the 27 patients who completed semi-structured questionnaires, 22 were HIV-infected and 17 received a monthly supply of RR TB treatment. Most HCWs and CCWs (10 and 32, respectively) understood the pilot programme; approximately half (n = 14) of the patients could not correctly describe the pilot programme. Overall, 11 and 41 HCWs and CCWs reported that the pilot programme promoted treatment adherence. Additionally, 11 HCWs reported that the pilot programme relieved pressure on the clinic. Key qualitative findings highlighted the importance of a support person and how the flexibility of SAT enabled integration of treatment into their daily routines and reduced time spent in clinics. The pilot programme was also perceived to allow patients more autonomy and made it easier for them to manage side-effects. Conclusion The SAT pilot programme was acceptable from the perspective of patients, HCWs and CCWs and should be considered as a differentiated model of care for RR-TB, particularly in settings with high burdens of HIV, in order to ease management of treatment for patients and health-care providers.
Collapse
Affiliation(s)
- Erika Mohr
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
- * E-mail:
| | - Leigh Snyman
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - Zodwa Mbakaz
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - Judy Caldwell
- City of Cape Town Health Department, Cape Town, South Africa
| | | | - Yulene Kock
- Provincial Government of the Western Cape Department of Health, Cape Town, South Africa
| | | | - Emilie Venables
- Southern Africa Medical Unit, Médecins Sans Frontières (MSF), Cape Town, South Africa
- University of Cape Town (UCT), Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, Cape Town, South Africa
| |
Collapse
|
39
|
Li L, Uyei J, Nucifora KA, Kessler J, Stevens ER, Bryant K, Braithwaite RS. Using value of information methods to determine the optimal sample size for effectiveness trials of alcohol interventions for HIV-infected patients in East Africa. BMC Health Serv Res 2018; 18:590. [PMID: 30064428 PMCID: PMC6069863 DOI: 10.1186/s12913-018-3356-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Unhealthy alcohol consumption exacerbates the HIV epidemic in East Africa. Potential benefits of new trials that test the effectiveness of alcohol interventions could not be evaluated by traditional sampling methods. Given the competition for health care resources in East Africa, this study aims to determine the optimal sample size given the opportunity cost of potentially re-allocating trial funds towards cost-effective alcohol treatments. Methods We used value of information methods to determine the optimal sample size by maximizing the expected net benefit of sampling for a hypothetical 2-arm intervention vs. control randomized trial, across ranges of policymaker’s willingness-to-pay for the health benefit of an intervention. Probability distributions describing the relative likelihood of alternative trial results were imputed based on prior studies. In the base case, policymaker’s willingness-to-pay was based on a simultaneously resource-constrained priority (routine HIV virological testing). Sensitivity analysis was performed for various willingness-to-pay thresholds and intervention durations. Results A new effectiveness trial accounting for the benefit of more precise decision-making on alcohol intervention implementation would benefit East Africa $67,000 with the optimal sample size of 100 persons per arm under the base case willingness-to-pay threshold and intervention duration of 20 years. At both a conservative willingness-to-pay of 1 x GDP/capita and a high willingness-to-pay of 3 x GDP/capita for an additional health gain added by an alcohol intervention, a new trial was not recommended due to limited decision uncertainty. When intervention duration was 10 or 5 years, there was no return on investment across suggested willingness-to-pay thresholds. Conclusions Value of information methods could be used as an alternative approach to assist the efficient design of alcohol trials. If reducing unhealthy alcohol use is a long-term goal for HIV programs in East Africa, additional new trials with optimal sample sizes ranging from 100 to 250 persons per arm could save the opportunity cost of implementing less cost-effective alcohol strategies in HIV prevention. Otherwise, conducting a new trial is not recommended.
Collapse
Affiliation(s)
- Lingfeng Li
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Jennifer Uyei
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kimberly A Nucifora
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA.
| | - Jason Kessler
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Elizabeth R Stevens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6, New York, NY, 10016, USA
| |
Collapse
|
40
|
Hayes-Larson E, Hirsch-Moverman Y, Saito S, Frederix K, Pitt B, Maama-Maime L, Howard AA. Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho. Int J Tuberc Lung Dis 2018; 21:34-41. [PMID: 29025483 DOI: 10.5588/ijtld.17.0062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes. OBJECTIVE To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study. DESIGN START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models. RESULTS Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma. CONCLUSION Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.
Collapse
Affiliation(s)
- E Hayes-Larson
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Y Hirsch-Moverman
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - S Saito
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| | - K Frederix
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - B Pitt
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - L Maama-Maime
- National Tuberculosis Control Programme, Lesotho Ministry of Health, Maseru Lesotho
| | - A A Howard
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York, USA
| |
Collapse
|
41
|
Adong J, Lindan C, Fatch R, Emenyonu NI, Muyindike WR, Ngabirano C, Winter MR, Lloyd-Travaglini C, Samet JH, Cheng DM, Hahn JA. The Relationship Between Spirituality/Religiousness and Unhealthy Alcohol Use Among HIV-Infected Adults in Southwestern Uganda. AIDS Behav 2018; 22:1802-1813. [PMID: 28555316 PMCID: PMC5708153 DOI: 10.1007/s10461-017-1805-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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 ≥50 ng/ml based on analysis of dried bloodspot 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 subscale 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.
Collapse
Affiliation(s)
- Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Christina Lindan
- Department of Medicine, University of California, San Francisco, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, USA
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Jeffrey H Samet
- School of Public Health, Boston University, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Debbie M Cheng
- School of Public Health, Boston University, Boston, MA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| |
Collapse
|
42
|
Wandera B, Tumwesigye NM, Nankabirwa JI, Kambugu AD, Mafigiri DK, Kapiga S, Sethi AK. Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study. PLoS One 2017; 12:e0180015. [PMID: 28665974 PMCID: PMC5493343 DOI: 10.1371/journal.pone.0180015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 06/08/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda. Methods PLHIV aged ≥ 18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ T-cell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ T-cell count. Results Of the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1–7) alcohol users while 270 (17.2%) were hazardous (AUDIT score ≥ 8) alcohol users. The overall median (IQR) baseline CD4+ T-cell count was 356 (243–516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and non-hazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77). The mean CD4+ T-cell count over 12 months was not different between hazardous alcohol users and non-alcohol users (non-ART group p = 0.88 and ART group p = 0.62), nor between non-hazardous alcohol users and non-alcohol users (and non-ART group p = 0.66 and ART group p = 0.20). Alcohol use was not associated with a significant natural direct effect on CD4+ T-cell count (1.37 95%CI [-1.78, 4.52] cells/μl, p = 0.39) but had a statistically significant natural indirect effect on reduction of CD4+ T-cell count (-0.91 cells/μl [-1.36, -0.45], p < 0.001) mediated through ART non-adherence. Conclusion Hazardous alcohol use among PLHIV was not directly associated with lower CD4+ T-cell count but had a significant natural indirect effect on CD4+ T-cell count mediated through ART non-adherence. Among PLHIV with lower than expected CD4+ T-cell count, alcohol consumption should be excluded as an underlying factor for non-adherence to ART and any interventions targeting alcohol use should tackle possible ART non-adherence.
Collapse
Affiliation(s)
- Bonnie Wandera
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Nazarius M. Tumwesigye
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Andrew D. Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - David K. Mafigiri
- Department of Social Work and Social administration, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Saidi Kapiga
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine and Mwanza Interventional Trials Unit, Mwanza, Tanzania
| | - Ajay K. Sethi
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| |
Collapse
|
43
|
Kelso-Chichetto NE, Plankey M, Abraham AG, Ennis N, Chen X, Bolan R, Cook RL. Association between alcohol consumption trajectories and clinical profiles among women and men living with HIV. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017. [PMID: 28621562 DOI: 10.1080/00952990.2017.1335317] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use is common among persons living with HIV (PLWH). It is unclear how alcohol consumption changes over time and if these changes are associated with clinical profiles. OBJECTIVE We aimed to describe the association between longitudinal patterns of alcohol consumption and the clinical profiles of PLWH. METHODS Data from the Women's Interagency HIV Study (n = 1123 women) and Multicenter AIDS Cohort Study (n = 597 men) from 2004 to 2013 were utilized. Group-based trajectory models were used to assess alcohol consumption patterns across 10 years. Generalized estimating equations were used to identify associations between clinical factors and alcohol consumption. All analyses were stratified by sex. RESULTS Four trajectories of alcohol use were identified in women and men (women: abstinent 38%, low: 25%, moderate: 30%, heavy: 7%; men: abstinent 16%, low: 69%, moderate: 9%, heavy: 5%). The Framingham Risk Score (women: adjusted odds ratio [AOR] 1.07, 95% confidence interval [CI] 1.04-1.09), years on ART (women: AOR 1.02, CI 1.00-1.05; men: AOR 1.05, CI 1.01-1.09), suboptimal ART adherence (men: AOR 1.23, CI 1.07-1.42), and unsuppressed viral load (women: AOR 1.82, CI 1.56-2.13; men: AOR 1.36, CI 1.17-1.58) were associated with increased odds for moderate drinking. The Framingham Risk Score (women: AOR 1.10, CI 1.07-1.14; men: AOR 1.12, CI 1.06-1.20), suboptimal adherence (women: AOR 1.25, CI 1.04-1.51), and unsuppressed viral load (women: AOR 1.78, CI 1.42-2.24) were associated with increased odds for heavy drinking. CONCLUSIONS Clinicians should consider screening patients for alcohol consumption, particularly if patients have comorbid medical conditions, suboptimal antiretroviral adherence, and/or detectable viral load.
Collapse
Affiliation(s)
- Natalie E Kelso-Chichetto
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| | - Michael Plankey
- b Department of Medicine , Georgetown University Medical Center , Washington , DC , USA
| | - Alison G Abraham
- c Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Nicole Ennis
- d Department of Clinical and Health Psychology , College of Public Health and Health Professions, University of Florida , Gainesville , FL , USA
| | - Xinguang Chen
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| | | | - Robert L Cook
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| |
Collapse
|
44
|
da Silva CM, Mendoza-Sassi RA, da Mota LD, Nader MM, de Martinez AMB. Alcohol use disorders among people living with HIV/AIDS in Southern Brazil: prevalence, risk factors and biological markers outcomes. BMC Infect Dis 2017; 17:263. [PMID: 28399823 PMCID: PMC5387222 DOI: 10.1186/s12879-017-2374-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 03/31/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Alcohol abuse is an important public health problem, frequently unrecognized among people living with HIV/AIDS (PLWHA), and requires investigation and intervention. It is usually associated with lower adherence to highly active antiretroviral therapy (HAART). It can also produce adverse clinical outcomes, such as changes in certain HIV markers, particularly CD4 cell counts and HIV viral loads (VLs). Thus, this study aimed to evaluate the prevalence of alcohol abuse among PLWHA, its associated risk factors and effects on CD4 cell counts and HIV VLs in southern Brazil. METHODS Between December 2012 and July 2013, 343 patients were interviewed at a reference hospital in southern Brazil. The instrument used was the Alcohol Use Disorder Identification Test (AUDIT), and a cutoff of eight points or more was applied. Socioeconomic, demographic, clinical and laboratory data were also collected. The statistical analysis included a Poisson regression to evaluate the factors associated with alcohol use disorder, and a linear regression was performed to assess the relationship between AUDIT scores and CD4 cell counts and HIV VLs. RESULTS Alcohol abuse was present in 28.6% of the respondents, and possible dependence was present in 5%. The risk factors identified included being male, mixed or black skin color, low education and the use of intravenous or inhaled drugs. A higher AUDIT score was associated with a lower CD4 cell count but was not associated with higher HIV VL values. CONCLUSIONS Our results show the importance of screening for alcohol abuse in this group. The prevalence of alcohol abuse was high, and it was associated with socioeconomic factors and the use of illicit drugs. Moreover, AUDIT score negatively affected CD4 cell counts as well.
Collapse
Affiliation(s)
| | | | - Luisa Dias da Mota
- Faculty of Medicine, Federal University of Rio Grande – FURG, Rio Grande, RS Brazil
| | - Maíba Mikhael Nader
- Faculty of Medicine, Federal University of Rio Grande – FURG, Rio Grande, RS Brazil
| | | |
Collapse
|
45
|
The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: Event-level findings from a daily diary study. Drug Alcohol Depend 2016; 167:103-11. [PMID: 27567968 PMCID: PMC5037036 DOI: 10.1016/j.drugalcdep.2016.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/14/2016] [Accepted: 07/29/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Using daily diary methods, we aimed to test the hypothesis that at the event-level consuming alcohol increases the likelihood that antiretrovirals (ARV) will be missed on a particular day. METHODS This prospective cohort study of 74 (52 female, 22 male) people living with HIV (PLHIV) in South Africa collected event-level data on ARV adherence and alcohol consumption using structured daily phone interviews over a period of 42days generating 2718 data points. We used generalized estimating equations (GEE) analyses to assess univariate and multivariate associations between alcohol and adherence, controlling for sociodemographics and testing for effect modification. RESULTS Controlling for sociodemographics, each alcohol measure was a statistically significant predictor of non-adherence on a particular day; any drinking compared to no drinking (daytime: AOR=3.18, 95% CI=2.25-4.49; evening: AOR=3.43, 95% CI=2.12-5.53), consuming more alcohol than one normally consumes (daytime: AOR=1.06, 95% CI=1.02-1.11; evening: AOR=1.10, 95% CI=1.05-1.15), and drinking at low to moderate risk level (daytime: 4.29, 95% CI=2.81-6.56; evening: AOR=4.24, 95% CI=2.38-7.54) and high to very high risk levels (daytime: AOR=2.31, 95% CI=1.56-3.42; evening: AOR=3.08, 95% CI=1.91-4.98) were all significantly related to missing ARVs in the daytime and evening. CONCLUSIONS These data provide support for an event-level relationship between alcohol and non-adherence. Interventions that mitigate alcohol use among people on ARVs or provide strategies to maintain optimal adherence among those who drink are needed.
Collapse
|
46
|
Veld DHI', Pengpid S, Colebunders R, Skaal L, Peltzer K. High-risk alcohol use and associated socio-demographic, health and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa. Int J STD AIDS 2016; 28:651-659. [PMID: 27448655 DOI: 10.1177/0956462416660016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcohol use may have a negative impact on the course of HIV disease and the effectiveness of its treatment. We studied patients with HIV who use alcohol and associated socio-demographic, health and psychosocial factors. Outcomes from this study may help in selecting patients from clinical practice with high-risk alcohol use and who are likely to benefit most from alcohol reduction interventions. In a cross sectional study in three primary health care clinics in Pretoria, South Africa, from January 2012 to June 2012, patients with HIV infection were interviewed and patients' medical files were reviewed to obtain data on levels of alcohol use (Alcohol Use Disorder Identification Test), patients' socio-demographic characteristics, HIV-related information, health related quality of life (WHOQoL-HIVBref), internalized AIDS stigma, symptoms of depression and adherence to antiretroviral therapy. Analyses consisted of descriptive statistics, bi- and multivariate logistic regression models. A total of 2230 patients (1483 [66.5%] female) were included. The median age was 37 years (interquartile range 31-43), 99.5% were black Africans, 1975 (88.6%) had started ART and the median time on ART was 22 months (interquartile range 9-40). No alcohol was used by 64% of patients, 8.9% were low risk drinkers, 25.1% of patients were hazardous or harmful drinkers and 2.0% had possible alcohol dependence. In multivariate analysis high-risk drinking was positively associated with male gender, never being married, tobacco use, a higher score for the 'level of independence'-domain measured with the WHOQoL-HIVBref questionnaire, and with more depressive symptoms compared to low-risk drinking. This study shows a high prevalence of hazardous or harmful drinking in patients with HIV infection (especially men) attending primary health care clinics in South Africa. Routine screening for alcohol use should be introduced in these clinics and harm reduction interventions should be evaluated, taking into account associated factors.
Collapse
Affiliation(s)
- Diana Huis In 't Veld
- 1 Epidemiology for Global Health Institute, University of Antwerp, Antwerp, Belgium.,2 FWO Research Foundation Flanders, Brussels, Belgium.,3 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Supa Pengpid
- 4 ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand.,5 Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Robert Colebunders
- 1 Epidemiology for Global Health Institute, University of Antwerp, Antwerp, Belgium.,3 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Linda Skaal
- 6 Department of Health System Management and Policy, University of Limpopo, Pretoria, South Africa.,7 Department of Social and Behavioral Health Sciences, University of Limpopo, Pretoria, South Africa
| | - Karl Peltzer
- 4 ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand.,8 HIV/AIDS, STIs & TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.,9 Department of Psychology, University of Limpopo, Sovenga, South Africa
| |
Collapse
|
47
|
Myers B, Sorsdahl K, Morojele NK, Kekwaletswe C, Shuper PA, Parry CDH. "In this thing I have everything I need": perceived acceptability of a brief alcohol-focused intervention for people living with HIV. AIDS Care 2016; 29:209-213. [PMID: 27435957 DOI: 10.1080/09540121.2016.1211242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although hazardous/harmful alcohol use impacts response to HIV treatment, there have been few attempts to deliver alcohol-reduction interventions within South African HIV treatment services. As a first step towards implementing alcohol-focused interventions in these settings, we explored patients' views of the acceptability of a brief motivational interviewing and problem-solving intervention. In-depth interviews were conducted with 11 patients recruited from three HIV treatment sites in Tshwane, South Africa, who had completed the intervention. Participants noted that the intervention was acceptable and appropriate. As a result of the intervention, participants reported less use of alcohol as a coping mechanism. They described greater use of problem-focused and emotional coping strategies for dealing with mutable and immutable problems, respectively. Their only recommendation for improving the intervention was the addition of booster sessions. Findings suggest that this intervention is acceptable to patients receiving HIV treatment and is perceived to be helpful for reducing their use of alcohol.
Collapse
Affiliation(s)
- Bronwyn Myers
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Katherine Sorsdahl
- c Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Neo K Morojele
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,d School of Public Health , University of the Witwatersrand , Witwatersrand , South Africa.,e School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Connie Kekwaletswe
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa
| | - Paul A Shuper
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,f Social and Epidemiological Research Department , Centre for Addiction and Mental Health , Toronto , ON , Canada.,g Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - Charles D H Parry
- a Alcohol, Tobacco and Other Drug Research Unit , South African Medical Research Council , Tygerberg , South Africa.,h Department of Psychiatry , Stellenbosch University , Stellenbosch , South Africa
| |
Collapse
|
48
|
Magidson JF, Saal W, Nel A, Remmert JE, Kagee A. Relationship between depressive symptoms, alcohol use, and antiretroviral therapy adherence among HIV-infected, clinic-attending patients in South Africa. J Health Psychol 2016; 22:1426-1433. [PMID: 26884445 DOI: 10.1177/1359105316628743] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite the prevalence of depression and alcohol use among HIV-infected individuals, few studies have examined their association together in relation to nonadherence to antiretroviral therapy in sub-Saharan Africa. This study examined depressive symptoms, alcohol use, and other psychosocial factors (stigma, demographic characteristics) in relation to nonadherence to antiretroviral therapy among clinic-attending, HIV-infected individuals in South Africa ( n = 101). Nonadherence was assessed using event-level measurement (missed doses over the past weekend). Multivariable logistic regression analyses revealed that only alcohol use, over and above depressive symptoms and education level, was associated with antiretroviral therapy nonadherence(AOR = 1.15; 95%CI = 1.02-1.29; p < .05). Findings point to the independent association of alcohol use and nonadherence to antiretroviral therapy above and beyond depressive symptoms.
Collapse
|
49
|
Abstract
This study examined the difference in dog owning between Japan and the United States, and the effect of these differences on dogs' behavioral characteristics. Behavioral evaluations of privately-owned dogs were obtained by using online questionnaire. We compared background and demographic information from the two countries and analyzed the effects of these differences on behavioral characteristics in dogs. The results indicated that there was a bias in the dog breeds kept in Japan compared to the United States and that Japanese dogs' body weight was lower than the US dogs. The main source of dog acquisition was pet stores in Japan and breeders and/or shelters in the United States. Multiple linear regression analysis found that Japanese dogs showed more aggression to household members and higher energy, restlessness and fear of non-social stimuli than US dogs, while US dogs showed more fear of unfamiliar persons, separation-related behavior and excitability. US dogs also showed higher levels of trainability and attachment to owners. The lower dog's body weight was, the higher the behavioral scores except for trainability were. When dogs that were obtained under 3 months of age were analyzed, the younger the dogs were when their owners obtained them, the higher the scores on some behavioral problem factors were. The higher rates of problem behaviors among Japanese dogs compared with US dogs suggest that the preference for small breed dogs and poor early development environment influenced the behavioral characteristics of dogs.
Collapse
|
50
|
Abler LA, Sikkema KJ, Watt MH, Eaton LA, Choi KW, Kalichman SC, Skinner D, Pieterse D. Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues. BMC Psychiatry 2014; 14:224. [PMID: 25095874 PMCID: PMC4149269 DOI: 10.1186/s12888-014-0224-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues. METHODS Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use. RESULTS Women reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an interaction between depressive and post-traumatic stress symptoms; women reported more alcohol use than usual at times when they had higher post-traumatic stress symptoms, and this increase in alcohol use was further exacerbated for women who also had higher depressive symptoms than usual. CONCLUSIONS These findings suggest that interventions targeting post-traumatic stress, especially when post-traumatic stress is comorbid with depression, may reduce alcohol use among South African women who drink.
Collapse
Affiliation(s)
- Laurie A Abler
- Duke Global Health Institute, Duke University, Duke Box 90519, 27708 Durham, NC USA
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Duke Box 90519, 27708 Durham, NC USA ,Department of Psychology and Neuroscience, Duke University, Durham, NC USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Duke Box 90519, 27708 Durham, NC USA
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT USA
| | - Karmel W Choi
- Department of Psychology and Neuroscience, Duke University, Durham, NC USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT USA
| | - Donald Skinner
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| | - Desiree Pieterse
- Unit for Research on Health and Society, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|