Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report
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...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2016-02, Vol.111 (2), p.272-279 |
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| creator | Hahn, Judith A. Emenyonu, Nneka I. Fatch, Robin Muyindike, Winnie R. Kekiibina, Allen Carrico, Adam W. Woolf-King, Sarah Shiboski, Stephen |
| description | 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 |
| doi_str_mv | 10.1111/add.13173 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4715487</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3921470141</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5503-b0e23c78fb9c8818ce828a7e3669886f036c50c0c73eaca33ca8bb0672fee2db3</originalsourceid><addsrcrecordid>eNqNks1u1DAUhSMEokNhwQsgS2xYNK0dJ_7ZIFWd0laqQEgtLC3HuZm4ZOxgx8C8Ck-Lp1NGwApvbOt-59wj-xbFS4KPSV4nuuuOCSWcPioWhDJc4rqmj4sFlqwpK1Ljg-JZjHcYYy5k_bQ4qBgVhEi6KH4uwYzWWbdC2nUoQOuT67bX5AbQ4zxskB6NH_yIjHcxrafZeoe6FLbQPADqbYgz2oAOyPfo8uoTMjoAsg6FFPSIblfZWR-hFLeKafBxGvRsu80I86BdNp490mm1BjejCGNfBph8mJ8XT3o9RnjxsB8Wt-_Ob84uy-sPF1dnp9elaRpMyxZDRQ0XfSuNEEQYEJXQHChjUgjWY8pMgw02nII2mlKjRdtixqseoOpaeli83flOqV1DZ3KMHFtNwa512Civrfq74uygVv6bqjlpasGzwZsHg-C_JoizWttoYBy1A5-iIpw1jZSCyf9BsWCM11VGX_-D3vkUXH6JTDWMU8klzdSrP8PvU__-4Qyc7IDvdoTNvk6w2o6OyqOj7kdHnS6X94esKHcKG2f4sVfo8EXlrrxRn99fqBtZyQYvPypBfwE9K8hB</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1756739793</pqid></control><display><type>article</type><title>Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Hahn, Judith A. ; Emenyonu, Nneka I. ; Fatch, Robin ; Muyindike, Winnie R. ; Kekiibina, Allen ; Carrico, Adam W. ; Woolf-King, Sarah ; Shiboski, Stephen</creator><creatorcontrib>Hahn, Judith A. ; Emenyonu, Nneka I. ; Fatch, Robin ; Muyindike, Winnie R. ; Kekiibina, Allen ; Carrico, Adam W. ; Woolf-King, Sarah ; Shiboski, Stephen</creatorcontrib><description>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.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/add.13173</identifier><identifier>PMID: 26381193</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Africa ; Alcohol Drinking - epidemiology ; Alcohol use ; Ambulatory Care ; biomarker ; Biomarkers - metabolism ; Breath Tests ; brief intervention ; Confidence intervals ; Consumption ; Female ; Glycerophospholipids - metabolism ; HIV ; HIV Infections - epidemiology ; HIV Infections - therapy ; Human immunodeficiency virus ; Humans ; Male ; phosphatidylethanol ; Risk-Taking ; Rural Health ; Self Report ; trend ; Uganda ; Uganda - epidemiology ; unhealthy alcohol use</subject><ispartof>Addiction (Abingdon, England), 2016-02, Vol.111 (2), p.272-279</ispartof><rights>2015 Society for the Study of Addiction</rights><rights>2015 Society for the Study of Addiction.</rights><rights>2016 Society for the Study of Addiction</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5503-b0e23c78fb9c8818ce828a7e3669886f036c50c0c73eaca33ca8bb0672fee2db3</citedby><orcidid>0000-0002-2697-8264</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fadd.13173$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fadd.13173$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26381193$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hahn, Judith A.</creatorcontrib><creatorcontrib>Emenyonu, Nneka I.</creatorcontrib><creatorcontrib>Fatch, Robin</creatorcontrib><creatorcontrib>Muyindike, Winnie R.</creatorcontrib><creatorcontrib>Kekiibina, Allen</creatorcontrib><creatorcontrib>Carrico, Adam W.</creatorcontrib><creatorcontrib>Woolf-King, Sarah</creatorcontrib><creatorcontrib>Shiboski, Stephen</creatorcontrib><title>Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>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.</description><subject>Adult</subject><subject>Africa</subject><subject>Alcohol Drinking - epidemiology</subject><subject>Alcohol use</subject><subject>Ambulatory Care</subject><subject>biomarker</subject><subject>Biomarkers - metabolism</subject><subject>Breath Tests</subject><subject>brief intervention</subject><subject>Confidence intervals</subject><subject>Consumption</subject><subject>Female</subject><subject>Glycerophospholipids - metabolism</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Male</subject><subject>phosphatidylethanol</subject><subject>Risk-Taking</subject><subject>Rural Health</subject><subject>Self Report</subject><subject>trend</subject><subject>Uganda</subject><subject>Uganda - epidemiology</subject><subject>unhealthy alcohol use</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks1u1DAUhSMEokNhwQsgS2xYNK0dJ_7ZIFWd0laqQEgtLC3HuZm4ZOxgx8C8Ck-Lp1NGwApvbOt-59wj-xbFS4KPSV4nuuuOCSWcPioWhDJc4rqmj4sFlqwpK1Ljg-JZjHcYYy5k_bQ4qBgVhEi6KH4uwYzWWbdC2nUoQOuT67bX5AbQ4zxskB6NH_yIjHcxrafZeoe6FLbQPADqbYgz2oAOyPfo8uoTMjoAsg6FFPSIblfZWR-hFLeKafBxGvRsu80I86BdNp490mm1BjejCGNfBph8mJ8XT3o9RnjxsB8Wt-_Ob84uy-sPF1dnp9elaRpMyxZDRQ0XfSuNEEQYEJXQHChjUgjWY8pMgw02nII2mlKjRdtixqseoOpaeli83flOqV1DZ3KMHFtNwa512Civrfq74uygVv6bqjlpasGzwZsHg-C_JoizWttoYBy1A5-iIpw1jZSCyf9BsWCM11VGX_-D3vkUXH6JTDWMU8klzdSrP8PvU__-4Qyc7IDvdoTNvk6w2o6OyqOj7kdHnS6X94esKHcKG2f4sVfo8EXlrrxRn99fqBtZyQYvPypBfwE9K8hB</recordid><startdate>201602</startdate><enddate>201602</enddate><creator>Hahn, Judith A.</creator><creator>Emenyonu, Nneka I.</creator><creator>Fatch, Robin</creator><creator>Muyindike, Winnie R.</creator><creator>Kekiibina, Allen</creator><creator>Carrico, Adam W.</creator><creator>Woolf-King, Sarah</creator><creator>Shiboski, Stephen</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2697-8264</orcidid></search><sort><creationdate>201602</creationdate><title>Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report</title><author>Hahn, Judith A. ; Emenyonu, Nneka I. ; Fatch, Robin ; Muyindike, Winnie R. ; Kekiibina, Allen ; Carrico, Adam W. ; Woolf-King, Sarah ; Shiboski, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5503-b0e23c78fb9c8818ce828a7e3669886f036c50c0c73eaca33ca8bb0672fee2db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Africa</topic><topic>Alcohol Drinking - epidemiology</topic><topic>Alcohol use</topic><topic>Ambulatory Care</topic><topic>biomarker</topic><topic>Biomarkers - metabolism</topic><topic>Breath Tests</topic><topic>brief intervention</topic><topic>Confidence intervals</topic><topic>Consumption</topic><topic>Female</topic><topic>Glycerophospholipids - metabolism</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Male</topic><topic>phosphatidylethanol</topic><topic>Risk-Taking</topic><topic>Rural Health</topic><topic>Self Report</topic><topic>trend</topic><topic>Uganda</topic><topic>Uganda - epidemiology</topic><topic>unhealthy alcohol use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hahn, Judith A.</creatorcontrib><creatorcontrib>Emenyonu, Nneka I.</creatorcontrib><creatorcontrib>Fatch, Robin</creatorcontrib><creatorcontrib>Muyindike, Winnie R.</creatorcontrib><creatorcontrib>Kekiibina, Allen</creatorcontrib><creatorcontrib>Carrico, Adam W.</creatorcontrib><creatorcontrib>Woolf-King, Sarah</creatorcontrib><creatorcontrib>Shiboski, Stephen</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hahn, Judith A.</au><au>Emenyonu, Nneka I.</au><au>Fatch, Robin</au><au>Muyindike, Winnie R.</au><au>Kekiibina, Allen</au><au>Carrico, Adam W.</au><au>Woolf-King, Sarah</au><au>Shiboski, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2016-02</date><risdate>2016</risdate><volume>111</volume><issue>2</issue><spage>272</spage><epage>279</epage><pages>272-279</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26381193</pmid><doi>10.1111/add.13173</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2697-8264</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0965-2140 |
| ispartof | Addiction (Abingdon, England), 2016-02, Vol.111 (2), p.272-279 |
| issn | 0965-2140 1360-0443 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Africa Alcohol Drinking - epidemiology Alcohol use Ambulatory Care biomarker Biomarkers - metabolism Breath Tests brief intervention Confidence intervals Consumption Female Glycerophospholipids - metabolism HIV HIV Infections - epidemiology HIV Infections - therapy Human immunodeficiency virus Humans Male phosphatidylethanol Risk-Taking Rural Health Self Report trend Uganda Uganda - epidemiology unhealthy alcohol use |
| title | 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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