Alcohol Use and Antiretroviral Therapy Non-Adherence Among Adults Living with HIV/AIDS in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.
ART adherence
Africa
Alcohol
HIV
Systematic review
Journal
AIDS and behavior
ISSN: 1573-3254
Titre abrégé: AIDS Behav
Pays: United States
ID NLM: 9712133
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
pubmed:
2
11
2019
medline:
2
6
2020
entrez:
2
11
2019
Statut:
ppublish
Résumé
Antiretroviral therapy (ART) is efficacious in improving clinical outcomes among people living with HIV (PLWH) and reducing HIV transmission when taken regularly. Research examining modifiable factors associated with ART non-adherence is critical for informing novel intervention development in settings with high HIV prevalence. Alcohol use has been linked with ART non-adherence in studies in sub-Saharan Africa; however, no review has pooled estimates across studies. We reviewed studies of alcohol use and ART non-adherence conducted in sub-Saharan Africa. We searched PubMed, CINAHL, EMBASE, and PsycINFO through August 2019 with terms related to ART non-adherence, alcohol use, and sub-Saharan Africa. One author reviewed titles/abstracts (n = 754) and two authors reviewed full texts (n = 308) for inclusion. Discrepancies were resolved by group consensus. Studies were retained if they quantitatively measured associations between alcohol use and ART non-adherence or viral non-suppression. We defined ART non-adherence using the definitions from each parent study (e.g., patients with > 5% missed ART doses during the previous four, seven or 30 days were considered non-adherent). A random effects meta-analysis was conducted to pool associations and we conducted additional analyses to assess between-study heterogeneity and publication bias and sensitivity analyses to determine robustness of our results when considering only certain study designs, alcohol use or ART scales, or studies that used viral non-suppression as their primary outcome. Of 56 articles meeting our inclusion criteria, 32 articles were included in the meta-analysis. All studies measured alcohol use via self-report. ART non-adherence was assessed using self-report, pill counts, or pharmacy records and definition of non-adherence varied depending on the measure used. Individuals who used alcohol had twice the odds of ART non-adherence compared with those who did not use alcohol (34% non-adherence among alcohol users vs. 18% among non-users; pooled odds ratio: 2.25; 95% confidence interval: 1.87-2.69; p < 0.001). We found evidence of a high degree of heterogeneity between studies (Cochrane Q statistic: 382.84, p< 0.001; I
Identifiants
pubmed: 31673913
doi: 10.1007/s10461-019-02716-0
pii: 10.1007/s10461-019-02716-0
pmc: PMC7190427
mid: NIHMS1541750
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1727-1742Subventions
Organisme : National Institute of Allergy and Infectious Diseases
ID : T32 AI07140
Organisme : NIAID NIH HHS
ID : T32 AI007140
Pays : United States
Organisme : NIMH NIH HHS
ID : F31 MH113420
Pays : United States
Organisme : NIMH NIH HHS
ID : F31 MH112397
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI027757
Pays : United States
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