Amanda P Miller1, Eileen V Pitpitan2, Susan M Kiene3, Anita Raj4, Sonia Jain5, María Luisa Zúñiga2, Dorean Nabulaku6, Fred Nalugoda6, Robert Ssekubugu6, Betty Nantume6, Godfrey Kigozi6, Nelson K Sewankambo7, Joseph Kagaayi6, Steven J Reynolds8, Kate Grabowski9, Maria Wawer10, Jennifer A Wagman11. 1. University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States; San Diego State University School of Public Health, San Diego, CA, United States. Electronic address: apmiller@health.ucsd.edu. 2. San Diego State University School of Social Work, San Diego, CA, United States. 3. San Diego State University School of Public Health, San Diego, CA, United States. 4. University of California, San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, La Jolla, CA, 92082, United States. 5. University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States. 6. Rakai Health Sciences Program, Entebbe, Uganda. 7. Rakai Health Sciences Program, Entebbe, Uganda; Makerere University School of Medicine, Kampala, Uganda. 8. Rakai Health Sciences Program, Entebbe, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, United States; Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States. 9. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States. 10. Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Medicine, Johns Hopkins School of Medicine, United States. 11. University of California, Los Angeles Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA, United States.
Abstract
BACKGROUND: Alcohol use is common among persons living with HIV (PWH) in Uganda and associated with poor HIV care outcomes; findings regarding the relationship between alcohol use and viral suppression (VS) have been inconclusive. METHODS: Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable models (GEE) were used to estimate associations between alcohol exposures and VS for the overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by ART use was explored. RESULTS: Over half (55 %) of participants (n = 3823 PWH) reported alcohol use at baseline; 37.8 % of those reporting alcohol use reported alcohol-related consequences. ART use and VS at baseline significantly differed by alcohol use with person reporting alcohol use being less likely to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among women but not men (adj. OR 0.72 95 % CI 0.58-0.89, p = 0.0031). However, among males who use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95 % CI 0.54-0.88, p = 0.0034). The relationships between both alcohol exposures and VS were not significant in models restricted to persons on ART. CONCLUSIONS: We provide sex-stratified estimates of associations between two alcohol measures and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use is adversely associated with VS but ART use mediates this pathway, suggesting that initiation and retention on ART are critical steps to addressing alcohol-related disparities in VS.
BACKGROUND: Alcohol use is common among persons living with HIV (PWH) in Uganda and associated with poor HIV care outcomes; findings regarding the relationship between alcohol use and viral suppression (VS) have been inconclusive. METHODS: Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable models (GEE) were used to estimate associations between alcohol exposures and VS for the overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by ART use was explored. RESULTS: Over half (55 %) of participants (n = 3823 PWH) reported alcohol use at baseline; 37.8 % of those reporting alcohol use reported alcohol-related consequences. ART use and VS at baseline significantly differed by alcohol use with person reporting alcohol use being less likely to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among women but not men (adj. OR 0.72 95 % CI 0.58-0.89, p = 0.0031). However, among males who use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95 % CI 0.54-0.88, p = 0.0034). The relationships between both alcohol exposures and VS were not significant in models restricted to persons on ART. CONCLUSIONS: We provide sex-stratified estimates of associations between two alcohol measures and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use is adversely associated with VS but ART use mediates this pathway, suggesting that initiation and retention on ART are critical steps to addressing alcohol-related disparities in VS.
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