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The Relationship Between Harmful Alcohol Use and Antiretroviral Non-adherence in People Accessing HIV Treatment in Cape Town, South Africa: An Event-Level Analysis

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Abstract

Harmful alcohol consumption can significantly compromise adherence to antiretroviral therapy (ART). Prior research has identified aggregate relationships between alcohol use and ART non-adherence, largely relying on concurrent assessment of these domains. There is relatively limited evidence on more nuanced day-level associations between alcohol use and ART non-adherence, despite potentially important clinical implications. We recruited adults with HIV treatment adherence challenges and harmful alcohol use (n = 53) from HIV care in South Africa. We examined relationships between alcohol use and same and next day ART adherence, accounting for the role of weekends/holidays and participant demographics, including gender. Results demonstrated that ART adherence was significantly worse on weekend/holiday days. Next day adherence was significantly worse in the context of weekend alcohol use and among men. These results suggest the importance of tailoring intervention strategies to support ART adherence during weekend drinking and for men engaged in heavy episodic drinking.

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Data reported in this paper are available on written request.

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Acknowledgements

We would like to acknowledge the rest of the Project Khanya team and study participants, as well as the City of Cape Town Health Department and the staff at the study clinic, for their time, input, and contributions to this study.

Funding

This study was funded by the National Institute of Drug Abuse (K23DA041901, PI: Magidson). ALR’s time on this manuscript was supported by the National Institute of Mental Health (F31MH123020, PI: Rose). ADLR's time on this manuscript was supported by the Institute of Education Sciences (R324A180032, PI: De Los Reyes).

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Authors and Affiliations

  1. Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA

    Alexandra L. Rose, Jennifer M. Belus, Christine Wan, Andres De Los Reyes & Jessica F. Magidson

  2. Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland

    Jennifer M. Belus

  3. Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA

    Tianzhou Ma

  4. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Jasper S. Lee

  5. HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa

    John A. Joska

  6. Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Lena S. Andersen

  7. Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Australia

    Bronwyn Myers

  8. Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa

    Bronwyn Myers

  9. Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Bronwyn Myers

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  1. Alexandra L. Rose
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Contributions

ALR conceptualized the research idea with JFM, managed extraction and cleaning of data, conducted the analyses, and wrote the first draft of the manuscript. JMB and TM provided guidance in conducting the analyses and provided edits to the manuscript. JSL provided guidance in cleaning of data and provided edits to the manuscript. CW extracted and cleaned data and provided edits to the manuscript. ADLR, JAJ, LSA, and BM provided substantive edits to the manuscript. JFM secured funding for the project, contributed to conceptualization of the research idea, and provided edits on the manuscript.

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Correspondence to Alexandra L. Rose.

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All procedures were approved by the University of Cape Town Health Sciences Faculty Human Research Ethics Committee (HREC 187/2018).

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Rose, A.L., Belus, J.M., Ma, T. et al. The Relationship Between Harmful Alcohol Use and Antiretroviral Non-adherence in People Accessing HIV Treatment in Cape Town, South Africa: An Event-Level Analysis. AIDS Behav 26, 2055–2066 (2022). https://doi.org/10.1007/s10461-021-03552-x

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