Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

Khem Narayan Pokhrel, Kalpana Gaulee Pokhrel, Sanjeev Raj Neupane, Vidya Dev Sharma, Khem Narayan Pokhrel, Kalpana Gaulee Pokhrel, Sanjeev Raj Neupane, Vidya Dev Sharma

Abstract

Background: People living with Human Immunodeficiency Virus (HIV) often suffer from alcohol-use disorders resulting in their poor health and treatment outcomes. Little is known about the association of harmful alcohol drinking with their adherence to anti-retroviral therapy (ART) and health-related quality of life (QOL) in low-resource settings.

Objective: This study aimed to investigate associations between harmful alcohol drinking, adherence to ART and health-related QOL in HIV-positive people, stratified by gender, in Nepal.

Methods: We conducted a cross-sectional study of 682 HIV-positive people on ART to measure their self-reported harmful alcohol drinking and non-adherence to ART in the previous month of data collection. We also measured health-related QOL using a WHOQOL-HIV BREF scale. The association between harmful alcohol drinking and non-adherence to ART was examined using multiple logistic regressions. Additionally, multiple linear regressions examined association between harmful alcohol drinking and QOL.

Results: Harmful alcohol drinking was associated with non-adherence to ART among men (AOR: 2.48, 95% CI: 1.50, 4.11, p < 0.001) and women (AOR: 2.52, 95% CI: 1.32, 4.80, p = 0.005). Men were more likely to have lower score for the psychological (β = -0.55, p = 0.021) and level of independence (β = -0.68, p = 0.018) domains when they had harmful alcohol drinking. Moreover, women were more likely to have lower scores for the physical (β = -1.01, p = 0.015), social relations (β = -0.82, p = 0.033), environmental (β = -0.88, p = 0.011), and spiritual (β = -1.30, p = 0.005) domains of QOL when they had harmful alcohol drinking.

Conclusions: Harmful alcohol drinking had a negative association with ART adherence and QOL in both HIV-positive men and women in Nepal. Screening for alcohol-use disorders and community-based counseling services should be provided while delivering ART services to improve treatment adherence and QOL.

Keywords: HIV; Nepal; anti-retroviral therapy; harmful alcohol drinking; quality of life.

Conflict of interest statement

No potential conflict of interest was reported by the authors.

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