Alcohol Use, Depressive Symptoms and the Receipt of Antiretroviral Therapy in Southwest Uganda
- 155 Downloads
Alcohol use and depressive symptoms are associated with reduced access to antiretroviral therapy (ART) in the developed world. Whether alcohol use and depressive symptoms limit access to ART in resource-limited settings is unknown. This cross-sectional study examined the association between alcohol use, depressive symptoms and the receipt of ART among randomly selected HIV-positive persons presenting for primary health care services at an outpatient HIV clinic in Uganda. Depressive symptoms were defined by the Hopkins Symptom Checklist and alcohol use was measured through frequency of consumption questions. Antiretroviral use was assessed using a standardized survey and confirmed by medical record review. Predictors of ART use were determined via logistic regression. Among 421 HIV-infected patients, factors associated with the receipt of ART were having at least primary education, having an opportunistic infection in the last 3 months, and not drinking within the last year.
KeywordsAntiretroviral therapy Alcohol use Depression Africa Access to care
The authors would like to acknowledge Lillian Namukasa, Nicholas Musinguzi, Peace Margaret Akantorana, and the staff of the ISS Clinic and MUST-UCSF Collaboration for their contributions to the implementation of the study. We would also like to acknowledge Dr. Paul Bolton of Boston University for generously providing the locally validated version of the Hopkins Symptom Check list. This study received funding from the National Institute on Alcohol Abuse and Alcoholism (NIAAA 15287, NIAAA 14784) and the National Institute of Mental Health (NIMH 54907).
- Babor, T. F., de la Fuente, J. R., Saunders, J. B., & Grant, M. (1992). AUDIT—The alcohol use disorders identification test: Guidelines for use in primary health care (1st ed.). Geneva: World Health Organization.Google Scholar
- Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test: Guidelines for use in primary care (2nd ed.). Geneva: World Health Organization.Google Scholar
- Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., Turner, B. J., Eggan, F., Beckman, R., Vitiello, B., Morton, S. C., Orlando, M., Bozzette, S. A., Ortiz-Barron, L., & Shapiro, M. (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of general psychiatry, 58, 721–728.PubMedCrossRefGoogle Scholar
- Bolton, P., & Ndogoni, L. (2001). Cross-cultural assessment of trauma-related mental illness (Phase II): A report of research conducted by World Vision Uganda and The Johns Hopkins University. US Agency for International Development, The Johns Hopkins University and World Vision International. Available at: http://www.certi.org/publications/policy/ugandafinahreport.htm. Accessed 17 November, 2005.
- Cunningham, W. E., Sohler, N. L., Tobias, C., Drainoni, M. L., Bradford, J., Davis, C., Cabral, H. J., Cunningham, C. O., Eldred, L., & Wong, M. D. (2006). Health services utilization for people with HIV infection: Comparison of a population targeted for outreach with the U.S. population in care. Medical Care, 44, 1038–1047.PubMedCrossRefGoogle Scholar
- Galvan, F. H., Bing, E. G., Fleishman, J. A., London, A. S., Caetano, R., Burnam, M. A., Longshore, D., Morton, S. C., Orlando, M., & Sharipo, M. (2002). The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: Results from the HIV cost and services utilization study. Journal of Studies on Alcohol, 63, 179–186.PubMedGoogle Scholar
- Harvard Program in Refugee Trauma. Hopkins Symptom Check list Manual. Harvard University. Available at http://www.hprt-cambridge.org/Layer3.asp?page_id=10. Accessed 20 November, 2005.
- Lyketsos, C. G., Hutton, H., Fishman, M., Schwartz, J., & Treisman, G. J. (1996). Psychiatric morbidity on entry to an HIV primary care clinic. Journal of Acquired Immune Deficiency Syndromes, 10, 1033–1039.Google Scholar
- McNaghten, A. D., Hanson, D. L., Dworkin, M. S., Jones, J. L., & the Adult/Adolescent Spectrum of HIV Disease Group. (2003). Differences in prescription of ART in a large cohort of HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 32, 499–505.Google Scholar
- Ministry of Health, Republic of Uganda (2003). National antiretroviral treatment and care guidelines for adults and children. (1st ed.). Kampala, Uganda: Ministry of Health Republic of Uganda.Google Scholar
- Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction, 88, 791–804.PubMedCrossRefGoogle Scholar
- Sebit, M. B., Chandiwana, S. K., Latif, A. S., Gomo, E., Acuda, S. W., Makoni, F., & Vushe, J. (2002). Neuropsychiatric aspects of HIV disease progression. Impact of traditional herbs on adult patients in Zimbabwe. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 26, 451–456.PubMedCrossRefGoogle Scholar
- Tucker, J. S., Burnam, A., Sherbourne, C. D., Kung, F. Y., & Gifford, A. L. (2003). Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. American Journal of Medicine, 114, 573–580.PubMedCrossRefGoogle Scholar
- UNAIDS (2006). UNAIDS/WHO AIDS Epidemic Update: December 2006. Available at: http://www.unaids.org/en/HIV_data/epi2006/default.asp. Accessed 30 June, 2007.
- Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well-being of depressed patients. Results from the medical outcomes study. Journal of the American Medical Association, 262, 914–919.PubMedCrossRefGoogle Scholar
- World Health Organization (2004). Global Status Report on Alcohol 2004. Available at: http://www.whqlibdoc.who.int/publications/2004/9241562722_(425KB).pdf. Accessed 1 December, 2006.
- World Health Organization. (2005). Uganda summary country profile for HIV/AIDS treatment scale-up. June 2005. Available at: http://www.who.int/3by5/support/june2005_uga.pdf. Accessed 15 October, 2006.
- World Health Organization. (2006). Progress on global access to HIV antiretroviral therapy: A report on “3 by 5” and beyond. World Health Organization and UNAIDS, March 2006. Available at: http://www.who.int/hiv/progreport2006_summary_en.pdf. Accessed 30 June, 2007.