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Cited by 47HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskSubstance Abuse Treatment and Outcomes

Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

Open access
Myers, B., Lombard, C., Joska, J. A., Abdullah, F., Naledi, T., Lund, C., Petersen Williams, P., Stein, D. J. +1 more·2021·AIDS and Behavior
DOI 10.1007/s10461-021-03263-3PMC PMC8560660
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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.

AI snapshot

Written from the paper’s full text.

TL;DR

Among 608 women living with HIV on ART in the Western Cape, South Africa, frequent heavy episodic drinking (HED) was associated with viral non-suppression, and suboptimal ART adherence partially mediated this relationship. Occasional HED was associated with suboptimal adherence but not directly with viral non-suppression.

Key findings

  • Frequent HED (≥3 times/week and ≥5 drinks/occasion) was associated with viral non-suppression versus no/light drinking (aOR 2.08, 95% CI 1.30–3.28); occasional HED was not (aOR 0.84, 95% CI 0.53–1.33).
  • Both occasional HED (aOR 3.07, 95% CI 1.78–5.30) and frequent HED (aOR 7.11, 95% CI 4.24–11.92) were associated with suboptimal ART adherence.
  • Mediation analysis showed frequent HED had a direct effect on viral non-suppression (OR 2.34, 95% CI 1.63–3.36) and a smaller indirect effect via adherence (OR 1.24, 95% CI 1.05–1.46), indicating partial mediation. Occasional HED had a non-significant total effect (OR 1.01, 95% CI 0.62–1.62) but a significant indirect effect through adherence (OR 1.11, 95% CI 1.03–1.21).
  • In the sample, 64.6% achieved viral suppression, 35.7% reported suboptimal adherence, and past-month drinking patterns were 53.0% no/light drinking, 32.9% occasional HED, and 14.1% frequent HED.

Methods

  • Baseline cross-sectional analysis of 608 women living with HIV on ART recruited May 2017–March 2019 from 24 primary care clinics in the Western Cape, South Africa, as part of Project MIND, a cluster randomized trial; eligibility included AUDIT score ≥8 or CES-D score ≥16.
  • Viral load was dichotomized as suppression (<40 copies/ml) versus non-suppression (≥40 copies/ml); alcohol use was categorized as no/light drinking, occasional HED, or frequent HED; ART adherence was measured with the CASE adherence index.
  • Analyses used survey-adjusted logistic and multinomial regression, generalized structural equation modeling, and logistic decomposition with bootstrapped confidence intervals to estimate direct and indirect effects, with significance set at p < 0.05.

Limitations

  • The paper states the sample was adult women recruited through a trial, 85% met criteria for probable depression, and findings may not be generalizable to all people on ART in South Africa; self-reported adherence and alcohol use may be affected by social desirability and recall bias; cross-sectional data preclude causal inference; violence exposure and transactional sex were not examined.
  • The paper also notes that viral load categories were dichotomized due to small cell sizes and that no/light drinking categories were combined because only 58 women reported light drinking.
  • Evident from the text: baseline-only data cannot confirm direction or clinical significance of pathways, and residual confounding by unmeasured factors remains possible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

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Crossref · 10.1007/s10461-021-03263-3

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among women living with HIV in the Western Cape, South Africa, occasional heavy episodic drinking (drinking >1 and ≤2 times per week and ≥5 drinks per occasion) is associated with greater odds of suboptimal ART adherence (aOR 3.07, 95% CI 1.78-5.30).

    “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.”
    • Also stated in: § Covariates Associated with the Exposure of Interest and Hypothesised Mediator · plain
      “women who reported past-year illicit drug use (aOR 3.63; 95% CI 1.76–7.48), probable depression (aOR 1.85; 95% CI 1.14–3.01), occasional HED (aOR 3.07; 95% CI 1.78–5.30) or frequent HED (aOR 7.11; 95% CI 4.24–11.92) had significantly greater odds of suboptimal ART adherence than those without these exposures.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported alcohol consumption accurately measures past-month alcohol use patterns.
  • Findingown data

    Among women living with HIV in the Western Cape, South Africa, frequent heavy episodic drinking (drinking ≥3 times per week and ≥5 drinks per occasion) is associated with greater odds of suboptimal ART adherence (aOR 7.11, 95% CI 4.24-11.92).

    “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.”
    • Also stated in: § Covariates Associated with the Exposure of Interest and Hypothesised Mediator · plain
      “women who reported past-year illicit drug use (aOR 3.63; 95% CI 1.76–7.48), probable depression (aOR 1.85; 95% CI 1.14–3.01), occasional HED (aOR 3.07; 95% CI 1.78–5.30) or frequent HED (aOR 7.11; 95% CI 4.24–11.92) had significantly greater odds of suboptimal ART adherence than those without these exposures.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported alcohol consumption accurately measures past-month alcohol use patterns.
  • Findingown data

    Among women living with HIV in the Western Cape, South Africa, frequent heavy episodic drinking is associated with viral non-suppression (OR 2.08, 95% CI 1.30-3.28).

    “Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported alcohol consumption accurately measures past-month alcohol use patterns.
  • Findingown data

    Among women living with HIV in the Western Cape, South Africa, suboptimal adherence partially mediates the relationship between frequent heavy episodic drinking and viral non-suppression.

    “Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The cross-sectional baseline data can support a mediation analysis of the effect of alcohol use patterns on viral non-suppression through adherence, meaning the temporal ordering and causal assumptions required for mediation hold.
    • Rests on an assumption: The mediation analysis is not confounded by unmeasured variables.
  • Findingown data

    In bivariate analyses among women living with HIV in the Western Cape, South Africa, only age, ART adherence, and patterns of alcohol use were significantly associated with viral load categories.

    “In bivariate analyses, only age (F(6, 10) = 4.87; p = 0.004), ART adherence (F(2, 22) = 7.53; p = 0.003), and patterns of alcohol use (F(4, 20) = 6.86; p = 0.001) were significantly associated with viral load categories (Table 1).”
    Quote in the paperSubstantial claim
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Findingnone given

    Our sample comprised adult women recruited as part of a trial, of whom 85% met criteria for probable depression.

    “Our sample comprised adult women recruited as part of a trial, of whom 85% met criteria for probable depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no evidence of significant interactions between age and drinking patterns or between drinking patterns and adherence.

    “We found no evidence of significant interactions between age and drinking patterns or drinking patterns and adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is relatively little information on how alcohol consumption patterns are associated with viral suppression among women living with HIV, and the extent to which this relationship is mediated by ART adherence.

    “However, there is relatively little information on how these alcohol consumption patterns are associated with viral suppression among WLWH, and the extent to which this relationship is mediated by ART adherence [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Erol A, Karpvak VM. Sex and gender-related differences in alcohol use and its consequences. Contemporary knowledge and future research considerations. Drug Alcohol Depend. 2015;156:1–13. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The analyses used Stata's survey analysis platform to account for clustering.

    “We used Stata’s survey analysis platform to account for clustering.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only about 69% of South African adult women living with HIV are virally suppressed.

    “only about 69% of South African adult women living with HIV (WLWH) are virally suppressed [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Marinda E, Simbayi L, Zuma K, Zungu N, Moyo S, Kondlo L, et al. Towards achieving the 90–90–90 HIV targets: results from the South African 2017 national HIV survey. BMC Public Health. 2020;20:1375. https://doi.org/10.1186/s12889-020-09457-z. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses found that combining the no-drinking and light-drinking categories had little effect on the results.

    “Sensitivity analyses (not reported here) found that combining these categories had little effect on the results.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Research has demonstrated sex differences in physiological responses to alcohol.

    “As research has demonstrated sex differences in physiological responses to alcohol [24]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Lipira L, Rao D, Nevin PE, Kemp CG, Cohen SE, Turan JM, et al. Patterns of alcohol use and associated characteristics and HIV-related outcomes among a sample of African-American women living with HIV. Drug Alcohol Depend. 2020;206:107753. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In South Africa, although more than 50% of the adult population abstain from alcohol, heavy episodic drinking is the normative pattern of alcohol use among people who drink.

    “Although a substantial proportion (> 50%) of the adult population abstain from using alcohol, heavy episodic drinking (HED) is the normative pattern of alcohol use amongst people who drink [6, 7].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Trangenstein PJ, Morojele NK, Lombard C, Jernigan DH, Parry CDH. Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control Study. Subst Abuse Treat Prev Policy. 2018;13:43. https://doi.org/10.1186/s13011-018-0182-1. source

      Not checked in the free run.

    • cites [7] World Health Organization (WHO). Global Status Report on Alcohol and Health 2018. Geneva: WHO. 2018. https://apps.who.int/iris/handle/10665/274603. Accessed 24 Feb 2021.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Self-reported adherence is strongly associated with HIV outcomes and is simpler to obtain than estimates from pill counts or biomarkers.

    “Self-reported adherence is strongly associated with HIV outcomes and is simpler to obtain than estimates from pill counts or biomarkers [33].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Mekuria LA, Prins JM, Yalew AW, Sprangers MA, Nieuwkerk NT. Which adherence measure—self-report, clinician recorded or pharmacy refill—is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring? Trop Med Int Health. 2016;21(7):856–69. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Viral non-suppression increases the likelihood of rapid disease progression and onward transmission to sexual partners.

    “As viral non-suppression increases the likelihood of rapid disease progression and onward transmission to sexual partners [4, 5]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Eisinger RW, Dieffenbach CW, Fauci AS. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. JAMA. 2019;321(5):451–2. source

      Not checked in the free run.

    • cites [5] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The two mediation studies produced conflicting results: one reported direct effects of alcohol use on viral suppression and indirect effects via adherence, whereas the other only found indirect effects through adherence.

    “These studies produced conflicting results: one reported direct effects of alcohol use on viral suppression and indirect effects via adherence [23], whereas the other only found indirect effects through adherence [20].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Cook RL, Zhou Z, Kelso-Chichetto NE, Janelle J, Morano JP, Somboonwit C, et al. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract. 2017;12(1):22. https://doi.org/10.1186/s13722-017-0090-0. source

      Not checked in the free run.

    • cites [20] Kahler CW, Liu T, Cioe PA, Bryant V, Pinkston MM, Kojic EM, et al. Direct and indirect effects of heavy alcohol use on clinical outcomes in a longitudinal study of HIV patients on ART. AIDS Behav. 2017;21(7):1825–35. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High levels of alcohol consumption are associated with poorer engagement and retention in HIV care and lower rates of ART adherence for people living with HIV in high income countries and in low-and-middle income countries within sub-Saharan Africa.

    “These patterns of alcohol consumption are of grave concern given evidence from systematic reviews that high levels of alcohol consumption are associated with poorer engagement and retention in HIV care and lower rates of ART adherence for PLWH in both high income countries [12, 13] and in LMICs within sub-Saharan Africa [14].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [12] Cichowitz C, Maraba N, Hamilton R, Charalambous S, Hoffman CJ. Depression and alcohol use disorder at antiretroviral therapy initiation led to disengagement from care in South Africa. PLoS ONE. 2017;12(12):e0189820. https://doi.org/10.1371/journal.pone.0189820. source

      Not checked in the free run.

    • cites [13] Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112:178–93. source

      Not checked in the free run.

    • cites [14] Grodensky CA, Golin CE, Ochtera RD, Turner BJ. Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases. J Stud Alcohol Drugs. 2012;73:899–910. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    South African women comprise about 60% of the estimated 7.9 million South Africans living with HIV.

    “South African women continue to be disproportionately affected by HIV—comprising about 60% of the estimated 7.9 million South Africans living with HIV [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Marinda E, Simbayi L, Zuma K, Zungu N, Moyo S, Kondlo L, et al. Towards achieving the 90–90–90 HIV targets: results from the South African 2017 national HIV survey. BMC Public Health. 2020;20:1375. https://doi.org/10.1186/s12889-020-09457-z. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some studies found no association between alcohol use and viral suppression after controlling for self-reported ART adherence, suggesting an indirect relationship with viral suppression explained by alcohol's association with adherence.

    “Some studies found no association between alcohol use and viral suppression after controlling for self-reported ART adherence, suggesting an indirect relationship with viral suppression explained by alcohol’s association with adherence [17–19].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Barai N, Monroe A, Lesko C, Hutton H, Lang C, Alvanzo A. The association between changes in alcohol use and changes in antiretroviral therapy adherence and viral suppression among women living with HIV. AIDS Behav. 2017;21(7):1836–45. source

      Not checked in the free run.

    • cites [18] Deiss RG, Mesner O, Agan BK, Ganesan A, Okulicz JF, Bavaro M, et al. Characterizing the association between alcohol and HIV virologic failure in a military cohort on antiretroviral therapy. Alcohol Clin Exp Res. 2016;40(3):529–35. source

      Not checked in the free run.

    • cites [19] Sacamano PL, Farley JE. Behavioral and other characteristics associated with HIV viral load in an outpatient clinic. PLoS ONE. 2016;11(11):e0166016. https://doi.org/10.1371/journal.pone.0166016. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Center for Adherence Support Evaluation (CASE) adherence index has been widely used in sub-Saharan Africa to measure adherence to ART.

    “We used the Center for Adherence Support Evaluation (CASE) adherence index [33, 34], a scale that has been widely used in sub-Saharan Africa to measure adherence to ART [34–36].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [33] Mekuria LA, Prins JM, Yalew AW, Sprangers MA, Nieuwkerk NT. Which adherence measure—self-report, clinician recorded or pharmacy refill—is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring? Trop Med Int Health. 2016;21(7):856–69. source

      Not checked in the free run.

    • cites [34] Mannheimer SB, Mukherjee R, Hirschhorn LR, Dougherty J, Celano SA, Ciccarone D, et al. The CASE adherence index: a novel method for measuring adherence to antiretroviral therapy. AIDS Care. 2006;18(7):853–61. source

      Not checked in the free run.

    • cites [35] Heestermans T, Browne JL, Aitken SC, Vervoet SC, Klipstein-Grobush K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health. 2016;1(4):e000125. https://doi.org/10.1136/bmjgh-2016-000125. source

      Not checked in the free run.

    • cites [36] Parry CD, Morojele NK, Myers BJ, Kekwaletswe CT, Manda SOM, Sorsdahl K, Ramjee G, et al. Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes - a randomised controlled trial protocol. BMC Infect Dis. 2014;14:500. https://doi.org/10.1186/1471-2334-14-500. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CASE adherence scores greater than 10 have been shown to correlate with self-reported adherence rates of 95% and viral suppression.

    “Scores > 10 have been shown to correlate with self-reported adherence rates of 95% and viral suppression [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Mannheimer SB, Mukherjee R, Hirschhorn LR, Dougherty J, Celano SA, Ciccarone D, et al. The CASE adherence index: a novel method for measuring adherence to antiretroviral therapy. AIDS Care. 2006;18(7):853–61. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Cook et al. specified patterns of drinking characterised by different degrees of frequency and quantity, noting that frequent heavy drinking impacted on viral suppression, but not other patterns of drinking marked by occasional heavy drinking, light drinking, or abstinence.

    “An exception has been Cook et al. [23] who specified patterns of drinking characterised by different degrees of frequency and quantity, noting that frequent heavy drinking impacted on viral suppression, but not other patterns of drinking marked by occasional heavy drinking, light drinking, or abstinence.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Cook RL, Zhou Z, Kelso-Chichetto NE, Janelle J, Morano JP, Somboonwit C, et al. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract. 2017;12(1):22. https://doi.org/10.1186/s13722-017-0090-0. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Generalised structural equation modelling allows for the analysis of categorical data using non-linear assumptions for modelling dichotomous data and provides a statistical test of coefficients from mediation analyses.

    “GSEM allows for the analysis of categorical data using non-linear assumptions for modelling dichotomous data and provides a statistical test of coefficients from mediation analyses [38, 39].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Albert JM, Geng C, Nelson S. Causal mediation analysis with a latent mediator. Biom J Biometrische Zeitschrift. 2016;58(3):535–48. source

      Not checked in the free run.

    • cites [39] Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural gequation modeling. Shanghai Arch Psychiatry. 2013;25(6):390–4.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Alcohol reduction counselling is not routinely provided in the context of HIV care, where alcohol messaging has focused on cessation rather than reduction to within low risk limits.

    “Alcohol reduction counselling is not routinely provided in the context of HIV care, where alcohol messaging has focused on cessation rather than reduction to within low risk limits [52, 53].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [52] Howard BN, Van Dorn R, Myers BJ, Zule WA, Browne FA, Carney T, et al. Barriers and facilitators to implementing an evidence-based woman-focused intervention in South African Health Services. BMC Health Services Res. 2017. https://doi.org/10.1186/s12913-017-2669-2. source

      Not checked in the free run.

    • cites [53] Satinsky EN, Myers B, Andersen LS, Kagee SA, Joska JA, Magidson JF. “Now we are told that we can mix”: messages and beliefs around simultaneous use of alcohol and ART. AIDS Behav. 2020;24:2680–90. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Social desirability bias may have led to over-reporting of adherence and under-reporting of alcohol use, leading to misclassification of participants into adherence and alcohol use categories.

    “Social desirability bias may have led to over-reporting of adherence and under-reporting of alcohol use leading to the misclassification of participants into adherence and alcohol use categories.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Data are cross-sectional and causal inferences between frequent HED and viral non-suppression cannot be established.

    “Finally, data are cross-sectional and causal inferences between frequent HED and viral non-suppression cannot be established.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Available case analysis was used to address missing data, and a total of 608 observations were included.

    “Using available case analysis to address missing data, a total of 608 observations were included.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Missing data are missing at random, so available case analysis yields unbiased estimates.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The multivariable analyses examined the independent effects of adherence and drinking patterns on viral non-suppression while adjusting for potential confounders.

    “This enabled us to examine the independent effects of adherence and drinking patterns on viral non-suppression while adjusting for potential confounders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    AUDIT-C scores are relatively blunt indicators of severity of alcohol consumption over a 12 month period, providing little insight into various patterns of alcohol consumption.

    “Although this study did collect other information on alcohol consumption, as reflected through AUDIT-C scores [10], these are relatively blunt indicators of severity of alcohol consumption over a 12 month period providing little insight into various patterns of alcohol consumption that were of interest in this study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Morojele N, Nkosi S, Kekwaletswe C, Shuper PA, Manda SO, Myers B, et al. Utility of brief versions of the Alcohol Use Disorders Identification Test (AUDIT) to identify excessive drinking among patients in HIV care in South Africa. J Stud Alcohol Drugs. 2017;78:88–96. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Generalised structural equation modelling was used to examine the potentially mediating effects of adherence on associations between drinking patterns and viral non-suppression while adjusting for other covariates.

    “Finally, we used generalised structural equation modelling (GSEM) to examine the potentially mediating effects of (i) adherence on associations between drinking patterns and viral non-suppression and (ii) drinking patterns on the relationship between age and viral non-suppression while adjusting for other covariates.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The cross-sectional baseline data can support a mediation analysis of the effect of alcohol use patterns on viral non-suppression through adherence, meaning the temporal ordering and causal assumptions required for mediation hold.
    • Rests on an assumption: The mediation analysis is not confounded by unmeasured variables.

  • May combine two claims.

    Interpretationown data

    Frequent HED was concentrated among younger women who were also most at risk for being virally non-suppressed.

    “Notably, this pattern of drinking was concentrated among younger women who were also most at risk for being virally non-suppressed.”
    Quote in the paperNot a substantial claim
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  • The paper relies on this without support.

    The cross-sectional baseline data can support a mediation analysis of the effect of alcohol use patterns on viral non-suppression through adherence, meaning the temporal ordering and causal assumptions required for mediation hold.

    “This paper analyses baseline data on women receiving treatment for HIV who participated in Project MIND—a three-arm cluster randomized controlled trial comparing the effectiveness of different resourcing approaches to integrating counselling for unhealthy alcohol use and depression into HIV care (Trial Registration Number: PACTR201610001825403).”
    “Finally, we used generalised structural equation modelling (GSEM) to examine the potentially mediating effects of (i) adherence on associations between drinking patterns and viral non-suppression and (ii) drinking patterns on the relationship between age and viral non-suppression while adjusting for other covariates.”

  • The paper relies on this without support.

    Self-reported alcohol consumption accurately measures past-month alcohol use patterns.

    “To examine frequency of alcohol consumption, participants were asked to recall the number of days they drank alcohol in the month preceding the baseline assessment.”
    “Quantity of standard alcoholic drinks consumed on a typical drinking day was assessed by a single questionnaire item, with categorical response options ranging from 0, 1–2 drinks, 3–4 drinks, 5–6 drinks, 7–9 drinks or 10 or more drinks.”

  • The paper relies on this without support.

    Missing data are missing at random, so available case analysis yields unbiased estimates.

    “Using available case analysis to address missing data, a total of 608 observations were included.”

  • The paper relies on this without support.

    The mediation analysis is not confounded by unmeasured variables.

    “Finally, we used generalised structural equation modelling (GSEM) to examine the potentially mediating effects of (i) adherence on associations between drinking patterns and viral non-suppression and (ii) drinking patterns on the relationship between age and viral non-suppression while adjusting for other covariates.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Community health workers often encounter patients with symptoms of substance use and depression due to the high prevalence of these conditions.

    “These CHWs often encounter patients with symptoms of SU and depression due to the high prevalence of these conditions (Myers et al., 2021, 2023; Peltzer et al., 2012).”

    From Siyakhana: A Hybrid Type 2 Effectiveness-Implementation Stepped-Wedge Trial to Reduce Stigma Towards Substance Use and Depression Among Community Health Workers in HIV/TB Care in South Africa (2025) · cites this paper as Myers et al., 2021

    The Methods section says HIV care providers screened clinic patients for alcohol use and low mood, and the Conclusion describes high rates of alcohol consumption. But the paper does not identify those providers as community health workers or establish that CHWs often encounter both conditions because of their prevalence. The Discussion cautions that the trial sample’s depression rate may not generalise to all people receiving ART. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Approximately one-third of clinic-based patients with HIV/TB screened positive for substance use or depression, with rates likely even higher among patients with HIV/TB care disengagement.

    “In our prior work (Magidson et al., 2021; Myers et al., 2022), approximately one-third of clinic-based patients with HIV/TB screened positive for SU or depression, with rates likely even higher among patients with HIV/TB care disengagement (Myers et al., 2021; Peltzer et al., 2012; Truong et al., 2021).”

    From Siyakhana: A Hybrid Type 2 Effectiveness-Implementation Stepped-Wedge Trial to Reduce Stigma Towards Substance Use and Depression Among Community Health Workers in HIV/TB Care in South Africa (2025) · cites this paper as Myers et al., 2021

    For the clause citing Myers et al. (2021), the Introduction (page unavailable) reports that high alcohol consumption is associated with poorer engagement and retention in HIV care. The paper does not compare screening-positive rates between clinic patients and those disengaged from care, and its study concerns women receiving HIV treatment rather than patients with HIV/TB. The approximately one-third figure is attached to other citations in the sentence. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Depression count exceeds the suboptimal-adherence group

    Minor

    Table 3 places 332 women with probable depression in the suboptimal-adherence column, although that column contains only 217 women in total.

  • Occasional-HED total-effect odds ratio differs between text and table

    Minor

    The mediation-results text gives the total-effect odds ratio for occasional HED as 1.10, while Table 5 gives 1.01 for the same effect.

  • Table 3 unemployed adherence counts do not total 399

    Minor

    Table 3 lists 141 unemployed women with suboptimal adherence and 133 with optimal adherence, totaling 274. Table 1 reports 399 unemployed women, and Table 3's printed percentages also do not fit a total of 274.

    Reported 399 · recomputed 274

  • Incorrect percentage for ages 31-39 in Table 1

    Minor

    The 32 women in the 40-999 copies/ml category are 17.3% of the 185 women aged 31-39, not 27.3%.

    Reported 27.3 · recomputed 17.297297

  • Incorrect viral-load percentage for high-school graduates

    Minor

    In Table 1, 11 of 77 women who completed high school represent 14.3%, not 12.9%.

    Reported 12.9 · recomputed 14.285714

  • Incorrect optimal-adherence percentage for women without a partner

    Minor

    In Table 3, 279 of 436 women without a partner have optimal adherence, which is 64.0%, not 67.0%.

    Reported 67 · recomputed 63.990826

  • Incorrect frequent-HED percentage for women without a partner

    Minor

    Table 2 reports 67 of 436 women without a partner as having frequent HED. That is 15.4%, not 50.4%.

    Reported 50.4 · recomputed 15.366972

7 of 7

The citation lists haven’t been fetched yet

References 51 · Cited by 47

Authors
Myers, B., Lombard, C., Joska, J. A., Abdullah, F., Naledi, T., Lund, C., Petersen Williams, P., Stein, D. J., & Sorsdahl, K. R.
Affiliations
  • South African Medical Research Council (ZA)
  • University of Cape Town (ZA)
Corresponding author
Myers, B.
ORCID
Venue
AIDS and Behavior
Publisher
Springer Science and Business Media LLC
Published
2021-04-19
Volume
25
Issue
11
Pages
3758-3769
ISSN
  • 1090-7165 (ISSN-L)
  • 1573-3254
DOI
10.1007/s10461-021-03263-3
PMC
PMC8560660
OpenAlex
W3153184739
Cited by
47
References
51
Citations by year
2026: 4 · 2025: 6 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 2
FWCI
3.00
Type
journal article
Language
en
Open access
Licence
Locations
  • AIDS and Behavior (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • eSpace (Curtin University) (submittedVersion, cc-by)
Funders
  • Medical Research Council (MR/M014290/1)
  • South African Medical Research Council
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
alcohol consumption, episodic heavy drinking, HIV viral suppression, antiretroviral therapy adherence, women living with HIV, mediation, alcohol interventions, Western Cape
MeSH terms
Alcohol Drinking, Ethanol, Female, Humans, South Africa, HIV Infections, Viral Load

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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