TY - JOUR
T1 - Recreational ART use among individuals living with HIV/AIDS in South Africa
T2 - Examining longitudinal ART initiation and viral suppression
AU - Magidson, Jessica F.
AU - Iyer, Hari S.
AU - Regenauer, Kristen S.
AU - Grelotti, David J.
AU - Dietrich, Janan J.
AU - Courtney, Ingrid
AU - Tshabalala, Gugu
AU - Orrell, Catherine
AU - Gray, Glenda E.
AU - Bangsberg, David R.
AU - Katz, Ingrid T.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Alcohol use
KW - Drug use
KW - HIV/AIDS
KW - Recreational antiretroviral therapy use
KW - South Africa
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U2 - 10.1016/j.drugalcdep.2019.02.009
DO - 10.1016/j.drugalcdep.2019.02.009
M3 - Article
C2 - 30953938
AN - SCOPUS:85063748992
SN - 0376-8716
VL - 198
SP - 192
EP - 198
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
ER -