Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study

Bernard Cerutti, Barbara Broers, Motlomelo Masetsibi, Olatunbosun Faturiyele, Likabelo Toti-Mokoteli, Mokete Motlatsi, Joelle Bader, Thomas Klimkait, Niklaus D Labhardt, Bernard Cerutti, Barbara Broers, Motlomelo Masetsibi, Olatunbosun Faturiyele, Likabelo Toti-Mokoteli, Mokete Motlatsi, Joelle Bader, Thomas Klimkait, Niklaus D Labhardt

Abstract

Background: Depression and alcohol use disorder have been shown to be associated with poor adherence to antiretroviral therapy (ART). Studies examining their association with viral suppression in rural Africa are, however, scarce.

Methods: This study reports prevalence of depressive symptoms and alcohol use disorder, and their potential association with adherence and viral suppression in adult patients on ART in ten clinics in rural Lesotho, Southern Africa.

Results: Among 1,388 adult patients (69 % women), 80.7 % were alcohol abstinent, 6.3 % were hazardous drinkers (men: 10.7 %, women: 4.4 %, p < 0.001). The prevalence of depressive symptoms was 28.8 % (men 20.2 %, women 32.7 %, p < 0.001). Both alcohol consumption (adjusted odds-ratio: 2.09, 95 % CI: 1.58-2.77) and alcohol use disorder (2.73, 95 % CI: 1.68-4.42) were significantly associated with poor adherence. There was, however, no significant association with viral suppression.

Conclusions: Whereas the results of this study confirm previously reported association of alcohol use disorder with adherence to ART, there was no association with viral suppression.

Trial registration: April 28th 2014; NCT02126696 .

Keywords: Africa; Alcohol; Depression; HIV, antiretroviral therapy; Medication adherence.

References

    1. UNAIDS. MDG 6: 15 years, 15 lessons of hope from the AIDS response. . Accessed 8 Mar 2016.
    1. Rabkin M, Kruk ME, El-Sadr WM. HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS Lond Engl. 2012;26(Suppl 1):S77–83. doi: 10.1097/QAD.0b013e3283558430.
    1. Mutevedzi PC, Newell M-L. Review: The changing face of the HIV epidemic in sub-Saharan Africa. Trop Med Int Health TM IH. 2014;19:1015–28. doi: 10.1111/tmi.12344.
    1. Apisarnthanarak A, Mundy LM. Long-term outcomes of HIV-infected patients with <95 % rates of adherence to nonnucleoside reverse-transcriptase inhibitors. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010;51:115–7. doi: 10.1086/653445.
    1. Glass TR, Sterne JAC, Schneider M-P, De Geest S, Nicca D, Furrer H, et al. Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality. AIDS. 2015;29:2195–200. doi: 10.1097/QAD.0000000000000782.
    1. Holtzman CW, Brady KA, Yehia BR. Retention in care and medication adherence: current challenges to antiretroviral therapy success. Drugs. 2015;75:445–54. doi: 10.1007/s40265-015-0373-2.
    1. Sinclair H, Pretorius A, Stein DJ. A counselling line for problem and pathological gambling in South Africa: Preliminary data analysis. J Behav Addict. 2014;3:199–202. doi: 10.1556/JBA.3.2014.017.
    1. Soboka M, Tesfaye M, Feyissa GT, Hanlon C. Alcohol use disorders and associated factors among people living with HIV who are attending services in south west Ethiopia. BMC Res Notes. 2014;7:828. doi: 10.1186/1756-0500-7-828.
    1. Monahan PO, Shacham E, Reece M, Kroenke K, Ong’or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24:189–97. doi: 10.1007/s11606-008-0846-z.
    1. Bonner K, Mezochow A, Roberts T, Ford N, Cohn J. Viral load monitoring as a tool to reinforce adherence: a systematic review. J Acquir Immune Defic Syndr 1999. 2013;64:74–8. doi: 10.1097/QAI.0b013e31829f05ac.
    1. UNAIDS. Epidemiological Fact Sheet on HIV and AIDS Lesotho. . Accessed 8 Mar 2016.
    1. Williams BG, Gouws E, Somse P, Mmelesi M, Lwamba C, Chikoko T, et al. Epidemiological Trends for HIV in Southern Africa: Implications for Reaching the Elimination Targets. Curr HIV/AIDS Rep. 2015;12:196–206. doi: 10.1007/s11904-015-0264-x.
    1. UNAIDS. Developing subnational estimates of HIV prevalence and the number of people living with HIV from survey data. JC2665E, 2014. . Accessed 8 Mar 2016.
    1. Labhardt ND, Bader J, Lejone TI, Ringera I, Puga D, Glass TR, et al. Is zidovudine first-line therapy virologically comparable to tenofovir in resource-limited settings? Trop Med Int Health TM IH. 2015;20:914–8. doi: 10.1111/tmi.12509.
    1. Labhardt ND, Keiser O, Sello M, Lejone TI, Pfeiffer K, Davies M-A, et al. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. J Int AIDS Soc. 2013;16:18616.
    1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addict Abingdon Engl. 1993;88:791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16:606–13.17. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Seth P, Glenshaw M, Sabatier JHF, Adams R, Du Preez V, DeLuca N, et al. AUDIT, AUDIT-C, and AUDIT-3: Drinking Patterns and Screening for Harmful, Hazardous and Dependent Drinking in Katutura, Namibia. PLoS One. 2015;10:e0120850. doi: 10.1371/journal.pone.0120850.
    1. Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210:653–61. doi: 10.1016/j.psychres.2013.07.015.
    1. Akena D, Joska J, Obuku EA, Stein DJ. Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda. AIDS Care. 2013;25:1245–52. doi: 10.1080/09540121.2013.764385.
    1. Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among hiv-infected individuals in south africa: Prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDs. 2008;22:147–58. doi: 10.1089/apc.2007.0102.
    1. Masimba P, Kituma E, Klimkait T, Horvath E, Stoeckle M, Hatz C, et al. Prevalence of Drug Resistance Mutations and HIV Type 1 Subtypes in an HIV Type 1-Infected Cohort in Rural Tanzania. AIDS Res Hum Retroviruses. 2013;29:1229–36.
    1. Labhardt ND, Lejone T, Setoko M, Poka M, Ehmer J, Pfeiffer K, et al. A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from lesotho. PLoS One. 2012;7:e47937. doi: 10.1371/journal.pone.0047937.
    1. Sangeda RZ, Mosha F, Prosperi M, Aboud S, Vercauteren J, Camacho RJ, et al. Pharmacy refill adherence outperforms self-reported methods in predicting HIV therapy outcome in resource-limited settings. BMC Public Health. 2014;14:1035. doi: 10.1186/1471-2458-14-1035.
    1. Ministry of Health and Social Welfare (MOHSW) Lesotho, ICF Macro. Lesotho Demographic and Health Survey 2009. MOHSW and ICF Macro; 2012. . Accessed 8 Mar 2016
    1. Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, et al. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41:871–86. doi: 10.1093/ije/dys037.
    1. Denison JA, Koole O, Tsui S, Menten J, Torpey K, van Praag E, et al. Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS Lond Engl. 2015;29:361–71. doi: 10.1097/QAD.0000000000000543.
    1. WHO. WHO | STEPwise approach to chronic disease risk factor surveillance [Internet]. . Accessed 8 Mar 2016.
    1. Siegfried N, Parry CDH, Morojele NK, Wason D. Profile of drinking behaviour and comparison of self-report with the CAGE questionnaire and carbohydrate-deficient transferrin in a rural Lesotho community. Alcohol Alcohol. 2001;36:243–8. doi: 10.1093/alcalc/36.3.243.
    1. Yaya I, Landoh DE, Saka B, Patchali PM, Wasswa P, Aboubakari A, et al. Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo. BMC Public Health. 2014;14:1308. doi: 10.1186/1471-2458-14-1308.
    1. Kekwaletswe CT, Morojele NK. Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus. Patient Prefer Adherence. 2014;8:401–13. doi: 10.2147/PPA.S55547.
    1. WHO. WHO | Lesotho [Internet]. . Accessed 8 Mar 2016.
    1. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr 1999. 2009;52:180–202. doi: 10.1097/QAI.0b013e3181b18b6e.
    1. WHO. WHO | Mental Health Atlas 2005. . Accessed 8 Mar 2016.
    1. Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16:2101–18. doi: 10.1007/s10461-011-0087-8.
    1. Marconi VC, Wu B, Hampton J, Ordóñez CE, Johnson BA, Singh D, et al. Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic. AIDS Patient Care STDs. 2013;27:657–68. doi: 10.1089/apc.2013.0263.
    1. Terasaki DJ, Gelaye B, Berhane Y, Williams MA. Anger expression, violent behavior, and symptoms of depression among male college students in ethiopia. BMC Public Health. 2009;9:13. doi: 10.1186/1471-2458-9-13.
    1. Wagner GJ, Holloway I, Ghosh-Dastidar B, Kityo C, Mugyenyi P. Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in uganda. J Psychosom Res. 2011;70:440–8. doi: 10.1016/j.jpsychores.2010.10.003.
    1. Pence BW, Gaynes BN, Atashili J, O'Donnell JK, Tayong G, Kats D, et al. Validity of an interviewer-administered patient health questionnaire-9 to screen for depression in hiv-infected patients in cameroon. J Affect Disord. 2012;143:208–13. doi: 10.1016/j.jad.2012.05.056.
    1. Adewuya AO, Ola BA, Afolabi OO. Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst nigerian university students. J Affect Disord. 2006;96:89–93. doi: 10.1016/j.jad.2006.05.021.
    1. Peltzer K, Naidoo P, Louw J, Matseke G, Zuma K, McHunu G, et al. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics in south africa: Results from a cluster randomized controlled trial. BMC Public Health. 2013;13:699. doi: 10.1186/1471-2458-13-699.
    1. Pengpid S, Peltzer K, Skaal L, Van der Heever H. Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in south africa: Results from a randomized controlled trial. BMC Public Health. 2013;13:644. doi: 10.1186/1471-2458-13-644.
    1. Bisson GP, Gross R, Bellamy S, Chittams J, Hislop M, Regensberg L, et al. Pharmacy refill adherence compared with CD4 count changes for monitoring hiv-infected adults on antiretroviral therapy. PLoS Med. 2008;5:e109. doi: 10.1371/journal.pmed.0050109.
    1. Haberer JE, Kiwanuka J, Nansera D, Muzoora C, Hunt PW, So J, et al. Realtime adherence monitoring of antiretroviral therapy among hiv-infected adults and children in rural uganda. AIDS. 2013;27:2166–8. doi: 10.1097/QAD.0b013e328363b53f.

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