Abstract
We examined whether alcohol use is associated with antiretroviral therapy (ART) adherence independently of structural and psychosocial factors among 304 male and female ART recipients in ART sites in Tshwane, South Africa. ART adherence was assessed by the CASE Adherence Index. Independent variables were demographic, structural, psycho-social, and alcohol use (AUDIT score) factors. In hierarchical multiple regression, demographic variables (Step 1) explained 4 % of variance in ART adherence (p ≤ 0.01). Variance explained increased to 16 % (p ≤ 0.001) after entering structural variables (Step 2); 19 % (p ≤ 0.001) after entering psychosocial variables (Step 3); and 24 % (p ≤ 0.001) after entering AUDIT score (Step 4). Alcohol use is independently associated with ART adherence.
References
Johnson LF. Access to antiretroviral treatment in South Africa, 2004–2011. South Afr J HIV Med. 2012;13(1):22–7.
Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America. J Assoc Nurses AIDS Care. 2006;296(6):679–90.
Hardon AP, Akurut D, Comoro C, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19(5):658–65.
Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Glob Public Health. 2011;6(1):83–97.
Dlamini PS, Wantland D, Makoae LN. HIV stigma and missed medications in HIV-positive people in five African countries. AIDS Patient Care STDS. 2009;23(5):377–87.
Stirratt MJ, Remien RH, Smith A, Copeland OQ, Dolezal C, Krieger D. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10:483–93.
Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112:178–93.
World Health Organization. Global status report on Alcohol and health. Geneva: World Health Organization; 2011.
Cohen J. Quantitative methods in psychology: a power primer. Psychol Bul. 1992;112(1):155–9.
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT. The alcohol use disorders identification test: guidelines for use in primary care. 2nd ed. Geneva: World Health Organization. Department of Mental Health and Substance Dependence; 2001.
Mannheimer SB, Mukherjee R, Hirschhorn LR, et al. The CASE Adherence Index: a novel method for measuring adherence to antiretroviral therapy. AIDS Care. 2006;18(7):853–61.
Jaffar S, Munderi P, Grosskurth H. Adherence to antiretroviral therapy in Africa: how high is it really? Trop Med Int Health. 2008;13(9):1096–7.
Kalichman SC, Amaral CM, White D, et al. Alcohol and adherence to antiretroviral medication: interactive toxicity beliefs among people living with HIV. J Assoc Nurses AIDS Care. 2012;23(6):511–20.
Skovdal M, Campbell C, Madanhire C, Mupambireyi Z, Nyamukapa C, Gregson S. Masculinity as a barrier to men’s use of HIV services in Zimbabwe. Glob Health. 2011;7(1):13–25.
Acknowledgments
This article was supported by Cooperative Agreement Number U2G/PS001137-02 from Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors would like to thank Ms. Mantoa Nzeku for managing the study and Ms. Naledi Kitleli and Mr. Kgalabi Ngako for supervising the field staff. We are indebted to the clinic sites’ managers and health care providers as well as the patients for consenting to participate in this study.
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Morojele, N.K., Kekwaletswe, C.T. & Nkosi, S. Associations Between Alcohol Use, Other Psychosocial Factors, Structural Factors and Antiretroviral Therapy (ART) Adherence Among South African ART Recipients. AIDS Behav 18, 519–524 (2014). https://doi.org/10.1007/s10461-013-0583-0
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DOI: https://doi.org/10.1007/s10461-013-0583-0