Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self‐report
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Aims: We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self‐report to using self‐report alone. Design: A prospective 1‐year observational cohort study with quarterly visits. Setting: Large rural HIV clinic in Mbarara, Uganda. Participants: A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption. Measurements: Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test–Consumption+ (AUDIT‐C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self‐reported prior unhealthy alcohol use. Findings: The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT‐C+) at baseline. There was no significant trend in unhealthy drinking overall [per‐month AOR: 1.01; 95% confidence interval (CI) = 0.94–1.07], while the per‐month AORs were 0.91 (95% CI = 0.83–1.00) and 1.11 (95% CI = 1.01–1.22) when participants were not yet on ART and on ART, respectively (interaction P ‐value < 0.01). In contrast, 44% were AUDIT‐C+; the per‐month AORs for being AUDIT‐C+ were 0.89 (95% CI = 0.85–0.95) overall, and 0.84 (95% CI = 0.78–0.91) and 0.97 (95% CI = 0.89–1.05) when participants were not on and were on ART, respectively. Conclusions: Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti‐retroviral therapy but rebounds with time. Augmenting self‐reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
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Approximately one in five people attending health care facilities in sub-Saharan Africa meet the criteria for AUD.
“Studies conducted in sub-Saharan Africa (SSA) have shown that approximately one in five people attending health care facilities meet the criteria for AUD (3–7).”
From Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review (2022) · cites this paper as [4]
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- [41]Hahn JA Fatch R Kabami J Self-Report of Alcohol Use Increases When Specimens for Alcohol Biomarkers Are Collected in Persons With HIV in Uganda J Acquir Immune Defic Syndr 2012 61 4 e63 e64 23138732 PMC3495104
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Self-citationHeavy Alcohol Use Among Women and Men Living With HIV in Uganda, Russia, and the United States
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Self-citationCorrelates and Effects of Alcohol Use Expectancies Among Persons Living with HIV in Uganda
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Digital Health Screening in Persons with HIV in Uganda to Increase Alcohol Reporting (Preprint)Preprint
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- Authors
- Hahn, J. A., Emenyonu, N. I., Fatch, R., Muyindike, W. R., Kekiibina, A., Carrico, A. W., Woolf‐King, S., & Shiboski, S.
- Affiliations
- University of California, San Francisco (US)
- Mbarara University of Science and Technology (UG)
- Mbarara University of Sciences and Technology Faculty of Medicine Mbarara Uganda
- Corresponding author
- Hahn, Judith A.
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2015-11-05
- Volume
- 111
- Issue
- 2
- Pages
- 272-279
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC4715487
- OpenAlex
- W1909348998
- Cited by
- 97
- References
- 39
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 25 · 2022: 13 · 2021: 9 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 10 · 2016: 9
- FWCI
- 6.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- US National Institutes of Health, (R01AA018631, U01AA020776, K24AA022586, K01AA021671, P30DK026743)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- phosphatidylethanol, alcohol biomarkers, AUDIT-C, antiretroviral therapy, alcohol consumption trends, health perception, HIV symptoms, Uganda, Mbarara, gender differences in drinking, HIV outcomes, Alcohol Use Disorders Identification Test
- MeSH terms
- Adult, Alcohol Drinking, Ambulatory Care, Breath Tests, Female, Humans, Male, Risk-Taking, Rural Health, Uganda, Biomarkers, HIV Infections, Glycerophospholipids, Self Report
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