TY - JOUR
T1 - Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa
AU - the META team
AU - Magidson, Jessica F.
AU - Fatch, Robin
AU - Orrell, Catherine
AU - Amanyire, Gideon
AU - Haberer, Jessica E.
AU - Hahn, Judith A.
AU - Haberer, Jessica
AU - Ware, Norma
AU - Bwana, Mwebesa Bosco
AU - Stephen, Asiimwe
AU - Gideon, Amanyire
AU - Elioda, Tumwesigye
AU - Bangsberg, David
AU - Tsai, Alex
AU - Siedner, Mark
AU - Matthews, Lynn
AU - Katz, Ingrid
AU - Wyatt, Monique
AU - April, Nomakhaya
AU - Mpahleni, Alienah
AU - Situlo, Vivie
AU - Mzamo, Speech
AU - Ngwenya, Nomsa
AU - Panda, Khosi Tshangela Regina
AU - Linda, Teboho
AU - Atwiine, Christine
AU - Moonight, Sheila
AU - Tindimwebwa, Edna
AU - Mugisha, Nicholas
AU - Atwogeire, Peace
AU - Namana, Vian
AU - Kyampaire, Catherine
AU - Nuwagaba, Gabriel
AU - Kembabazi, Annet
AU - Mugisha, Stephen
AU - Nanfuka, Victoria
AU - Cross, Anna
AU - Kelly, Nicky
AU - Moralie, Daphne
AU - Bell, Kate
AU - Musinguzi, Nicholas
AU - Cogill, Dolphina
AU - Ashaba, Justus
AU - Xapa, Zoleka
AU - Orimwesiga, Mathias
AU - Tuhanamagyezi, Elly
AU - Kyampaire, Catherine
AU - Mpanga, Don Bosco
AU - Kyarisima, Leonia
AU - Kigozi, Simone
N1 - Funding Information:
We would also like to thank the study participants and acknowledge the META study team: Principal Investigators: Dr. Jessica Haberer, Dr. Catherine Orrell, Dr. Norma Ware, Dr. Mwebesa Bosco Bwana, Dr. Asiimwe Stephen, Dr. Amanyire Gideon, Hon. Dr. Tumwesigye Elioda, Dr. David Bangsberg; Co-Investigators: Dr. Alex Tsai, Dr. Mark Siedner, Dr. Lynn Matthews, Dr. Ingrid Katz, Monique Wyatt; Research Assistants: Nomakhaya April (RN), Alienah Mpahleni, Vivie Situlo, Speech Mzamo, Nomsa Ngwenya, Khosi Tshangela Regina Panda, Teboho Linda, Christine Atwiine, Sheila Moonight, Edna Tin-dimwebwa, Nicholas Mugisha, Peace Atwogeire, Dr. Vian Namana, Catherine Kyampaire, Gabriel Nuwagaba; Program Managers: Annet Kembabazi, Stephen Mugisha, Victoria Nanfuka, Anna Cross, Nicky Kelly, Daphne Moralie, Kate Bell; Statistician: Nicholas Musin-guzi; Data Managers: Dolphina Cogill, Justus Ashaba, Zoleka Xapa, Mathias Orimwesiga, Elly Tuhanamagyezi, Catherine Kyampaire; Lab Managers: Don Bosco Mpanga, Leonia Kyarisima, Simone Kigozi. Drivers: Edgar October, Silver Mugisha, Ibrahim Kiviiri Funding This study was supported by the Bill and Melinda Gates Foundation (OPP1056051). Dr. Magidson’s time was supported by K23DA041901. Dr. Hahn’s time and PEth testing was supported by NIH/NIAAA K24AA022586.
Publisher Copyright:
© 2018, The Author(s).
PY - 2019/6/15
Y1 - 2019/6/15
N2 - 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.
AB - 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.
KW - Alcohol use
KW - Biomarker
KW - HIV treatment
KW - Sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85058700450&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058700450&partnerID=8YFLogxK
U2 - 10.1007/s10461-018-2364-2
DO - 10.1007/s10461-018-2364-2
M3 - Article
C2 - 30560484
AN - SCOPUS:85058700450
SN - 1090-7165
VL - 23
SP - 1656
EP - 1667
JO - AIDS and Behavior
JF - AIDS and Behavior
IS - 6
ER -