Alcohol is the most commonly used recreational drug in sub-Saharan Africa, where the majority of HIV cases are located. Uganda has one of the highest rates of per capita alcohol consumption in the world. Alcohol has a substantial impact on the sub-Saharan African HIV epidemic via increased risk for sexual transmission of HIV and decreased adherence to antiretroviral therapy (ART), which may lead to treatment failure. We have observed a high rate of self-reported natural recovery from hazardous drinking in the absence of alcohol treatment in a cohort of HIV positives initiating ART in Mbarara, Uganda. More than half (56%) of participants who reported hazardous drinking in the year prior to study entry and 70% of those who reported moderate drinking in the prior year reported that they had abstained from drinking alcohol in the prior 3 months. The majority of those who reported that they had stopped drinking remained abstinent throughout follow-up of up to three years. It is possible that decreases in self-reported alcohol consumption are due to under-report of current versus past alcohol use as a result of stigma associated with alcohol consumption or fear of losing access to ART. On the other hand, decreases may be due to real reductions in alcohol consumption concurrent with declining health, behavioral counseling conducted at the HIV clinic, or pressure from family, friends, and/or treatment supporters. We propose a prospective cohort study of 212 HIV positive alcohol consumers to quantify changes in alcohol consumption during the first year of HIV care. We have recently validated several biomarkers of heavy alcohol consumption-direct metabolites of alcohol that may be detected for extended periods of time after alcohol itself has left the body-and we propose to use the best of these measures as an adjunct to self-report and to estimate under-report of heavy alcohol consumption. We will conduct qualitative observations of HIV clinic sessions (n=60) in order to examine how alcohol reduction is approached in that setting. We will additionally examine reasons for changes in alcohol consumption in quantitative and qualitative studies, using prior clinic observations to inform this inquiry. The long-term goal of this study is to quantify changes in alcohol consumption during HIV care and to determine factors predictive of such change to inform future interventions to decrease alcohol consumption. This proposal is directly responsive to the NIAAA Five-Year Strategic Plan goal to identify biological and contextual social factors that contribute to changes in drinking behavior.

Public Health Relevance

While alcohol consumption is a significant problem in sub-Saharan Africa, there are few interventions to reduce heavy drinking in resource-limited settings. This study will objectively measure changes in alcohol consumption and examine determinants of changes among HIV positives in HIV care in Uganda. This study will provide vital information about feasible and culturally appropriate ways to reduce heavy drinking in HIV positives in care. Such methods may also be applicable to wider medical settings such as primary care in resource-poor countries.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA018631-04
Application #
8452722
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Roach, Deidra
Project Start
2010-07-15
Project End
2014-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
4
Fiscal Year
2013
Total Cost
$479,052
Indirect Cost
$63,139
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Hahn, Judith A; Emenyonu, Nneka I; Fatch, Robin et al. (2016) Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction 111:272-9
Fatch, Robin; Emenyonu, Nneka I; Muyindike, Winnie et al. (2016) Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda. AIDS Behav :
Hahn, Judith A; Anton, Raymond F; Javors, Martin A (2016) The Formation, Elimination, Interpretation, and Future Research Needs of Phosphatidylethanol for Research Studies and Clinical Practice. Alcohol Clin Exp Res 40:2292-2295
Woolf-King, Sarah E; Muyindike, Winnie; Hobbs, Marcia M et al. (2016) Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women. AIDS Behav :
Carrico, Adam W; Hunt, Peter W; Emenyonu, Nneka I et al. (2015) Unhealthy Alcohol Use is Associated with Monocyte Activation Prior to Starting Antiretroviral Therapy. Alcohol Clin Exp Res 39:2422-6
Woolf-King, Sarah E; Fatch, Robin; Emenyonu, Nneka et al. (2015) Development and validation of the East Africa Alcohol Expectancy Scale (AFEXS). J Stud Alcohol Drugs 76:336-43
Sundararajan, Radhika; Wyatt, Monique A; Woolf-King, Sarah et al. (2015) Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda. AIDS Behav 19:732-41
Asiimwe, Stephen B; Fatch, Robin; Emenyonu, Nneka I et al. (2015) Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa. Alcohol Clin Exp Res 39:1518-27
Hahn, Judith A; Fatch, Robin; Wanyenze, Rhoda K et al. (2014) Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda. BMC Infect Dis 14:403
Bajunirwe, Francis; Haberer, Jessica E; Boum 2nd, Yap et al. (2014) Comparison of self-reported alcohol consumption to phosphatidylethanol measurement among HIV-infected patients initiating antiretroviral treatment in southwestern Uganda. PLoS One 9:e113152

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