Point-of-Care Urine Ethyl Glucuronide Testing to Detect Alcohol Use Among HIV-Hepatitis B Virus Coinfected Adults in Zambia
In an HIV-hepatitis B virus (HIV-HBV) coinfection cohort in Zambia, we piloted a qualitative point-of-care (POC) test for urine Ethyl glucuronide (uEtG), assessed concordance between uEtG and alcohol use disorders identification test-consumption (AUDIT-C), and identified epidemiological factors associated with underreporting (defined as uEtG-positivity with last reported drink > 7 days prior). Among 211 participants (40.8% women), there were 44 (20.8%) lifetime abstainers, 32 (15.2%) former drinkers, and 135 (64.0%) current drinkers, including 106 (50.2%) with unhealthy drinking per AUDIT-C. Eighty-seven (41.2%) were uEtG-positive including 64 of 65 (98.5%) who drank ≤ 3 days prior and 17 of 134 (12.7%) underreported, all of whom admitted to recent drinking when results were discussed. uEtG was moderately concordant with AUDIT-C. Past drinking (versus lifetime abstinence) and longer time on antiretrovirals (≥ 12 months) were associated with underreporting. These data support further use of POC alcohol biomarkers in HIV and hepatitis research and clinical settings.
KeywordsAlcohol use disorder HIV/AIDS Africa Hepatitis B virus Ethyl glucuronide Alcohol biomarker
We acknowledge the CIDRZ Hep Team for their dedication to the HIV-HBV coinfection cohort and their specific role in Ethyl glucuronide testing and alcohol reduction counseling for this study. This study was funded by the Fogarty International Center (K01TW009998) and the National Institute of Allergy and Infectious Diseases (U01AI120796) at the U.S. National Institutes of Health.
- 10.Asiimwe SB, Fatch R, Emenyonu NI, Muyindike WR, Kekibiina A, Santos GM, et al. Comparison of traditional and novel self-report measures to an alcohol biomarker for quantifying alcohol consumption among HIV-infected adults in sub-Saharan Africa. Alcoholism. 2015;39(8):1518–27.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Jatlow PI, Agro A, Wu R, Nadim H, Toll BA, Ralevski E, et al. Ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. Alcoholism. 2014;38(7):2056–65.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Papas RK, Gakinya BN, Mwaniki MM, Keter AK, Lee H, Loxley MP, et al. Associations between the phosphatidylethanol alcohol biomarker and self-reported alcohol use in a sample of HIV-infected outpatient drinkers in western Kenya. Alcoholism. 2016;40(8):1779–87.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Zambian Ministry of Health. Zambia consolidated guidelines for the treatment and prevention of HIV infection. Zambia: Lusaka; 2014.Google Scholar
- 28.McDonell MG, Leickly E, McPherson S, Skalisky J, Srebnik D, Angelo F, et al. A randomized controlled trial of ethyl glucuronide-based contingency management for outpatients with co-occurring alcohol use disorders and serious mental illness. Am J Psychiatry. 2017;174(4):370–7.CrossRefPubMedPubMedCentralGoogle Scholar