title: Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus.
abstract: BACKGROUND
  The primary objectives of this study were to determine the association between alcohol and antiretroviral therapy (ART) adherence and the perceived appropriateness and acceptability of elements of an adherence counseling program with a focus on alcohol-related ART nonadherence among a sample of ART recipients in human immunodeficiency virus (HIV) clinics in Tshwane, South Africa.
  
  
  METHODS
  We conducted a cross-sectional study with purposive sampling. The sample comprised 304 male and female ART recipients at two President's Emergency Plan For AIDS Relief-supported HIV clinics. Using an interview schedule, we assessed patients' alcohol use (Alcohol Use Disorders Identification Test), other drug use, level of adherence to ART, and reasons for missing ART doses (AIDS Clinical Trials Group adherence instrument). Additionally, patients' views were solicited on: the likely effectiveness of potential facilitators; the preferred quantity, duration, format, and setting of the sessions; the usefulness of having family members/friends attend sessions along with the patient; and potential skill sets to be imparted.
  
  
  RESULTS
  About half of the male drinkers' and three quarters of the female drinkers' Alcohol Use Disorders Identification Test scores were suggestive of hazardous or harmful drinking. Average self-reported ART adherence was 89.7%. There was a significant association between level of alcohol use and degree of ART adherence. Overall, participants perceived two clinic-based sessions, each of one hour's duration, in a group format, and facilitated by a peer or adherence counselor, as most appropriate and acceptable. Participants also had a favorable attitude towards family and friends accompanying them to the sessions. They also favored an alcohol-focused adherence counseling program that employs motivational interviewing and cognitive behavioral therapy-type approaches.
  
  
  CONCLUSIONS
  The association between alcohol use and ART nonadherence points to a need for alcohol-focused ART adherence interventions. Patients' perceptions suggest their amenability to clinic-based brief motivational interviewing and cognitive behavioral therapy-type adherence interventions delivered by lay persons in group settings. Further research should investigate how best to implement such interventions in the existing health system.
authors.affiliation: Alcohol and Drug Abuse Research Unit, Medical Research Council, Pretoria, South Africa.
authors.forename: Connie T
authors.initials: CT
authors.lastname: Kekwaletswe
authors.affiliation: Alcohol and Drug Abuse Research Unit, Medical Research Council, Pretoria, South Africa ; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neo K
authors.initials: NK
authors.lastname: Morojele
keywords: South Africa; adherence; alcohol; antiretroviral therapy; patient perception
references.citation: J Gen Intern Med. 2009 Jan;24(1):80-5
references.pmid: 18972089
references.citation: J Health Psychol. 2009 May;14(4):578-86
references.pmid: 19383658
references.citation: J Health Psychol. 2010 Oct;15(7):1001-11
references.pmid: 20801946
references.citation: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S23-35
references.pmid: 17133201
references.citation: J Acquir Immune Defic Syndr. 2008 Sep 1;49(1):107-10
references.pmid: 18667926
references.citation: Addiction. 1993 Jun;88(6):791-804
references.pmid: 8329970
references.citation: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S127-33
references.pmid: 17133196
references.citation: J Stud Alcohol Drugs. 2009 Jul;70(4):516-27
references.pmid: 19515291
references.citation: Alcohol Clin Exp Res. 2005 Jul;29(7):1190-7
references.pmid: 16046874
references.citation: Int J Equity Health. 2004 Apr 15;3(1):1
references.pmid: 15084250
references.citation: JAMA Intern Med. 2013 Feb 25;173(4):306-7
references.pmid: 23358810
references.citation: Can J Psychiatry. 2012 Jun;57(6):350-8
references.pmid: 22682572
references.citation: AIDS Care. 2011 Feb;23(2):146-51
references.pmid: 21259126
references.citation: Alcohol Clin Exp Res. 2001 Nov;25(11):1634-47
references.pmid: 11707638
references.citation: Asia Pac Fam Med. 2009 Jan 23;8(1):1
references.pmid: 19161636
references.citation: AIDS Behav. 2014 Mar;18(3):519-24
references.pmid: 23934270
references.citation: Global Health. 2011 May 15;7:13
references.pmid: 21575149
references.citation: Health Soc Care Community. 2010 Mar;18(2):139-46
references.pmid: 19708868
references.citation: J Acquir Immune Defic Syndr. 2009 Dec 1;52(4):465-473
references.pmid: 19911481
references.citation: AIDS Care. 2000 Jun;12(3):255-66
references.pmid: 10928201
references.citation: Addiction. 2010 Aug;105(8):1416-21
references.pmid: 20528816
references.citation: AIDS Res Hum Retroviruses. 2010 Jun;26(6):685-91
references.pmid: 20518649
references.citation: Psychiatr Clin North Am. 2010 Sep;33(3):511-25
references.pmid: 20599130
references.citation: Addiction. 2011 Dec;106(12):2156-66
references.pmid: 21631622
references.citation: AIDS Care. 2013;25(4):496-502
references.pmid: 22881133
references.citation: Ann Intern Med. 2007 Apr 17;146(8):564-73
references.pmid: 17438315
references.citation: AIDS. 2014 Jan 2;28(1):115-20
references.pmid: 23939234
references.citation: South Afr J HIV Med. 2017 Jul 27;18(1):694
references.pmid: 29568630
references.citation: AIDS Behav. 2011 Nov;15(8):1795-802
references.pmid: 21424272
references.citation: Addiction. 2001 Aug;96(8):1161-74
references.pmid: 11487422
references.citation: Alcohol Clin Exp Res. 2002 Feb;26(2):272-9
references.pmid: 11964568
references.citation: Patient Educ Couns. 2007 Apr;66(1):29-36
references.pmid: 17188453
references.citation: PLoS One. 2008 Jul 30;3(7):e2783
references.pmid: 18665246
references.citation: J Gen Intern Med. 2013 Mar;28(3):399-405
references.pmid: 23065532
references.citation: AIDS Care. 2013;25(12):1504-12
references.pmid: 23517180
references.citation: HIV Med. 2006 Jul;7(5):285-90
references.pmid: 16945072
references.citation: Patient Prefer Adherence. 2013 Oct 22;7:1091-9
references.pmid: 24174871
references.citation: Med Clin (Barc). 2005 Nov 26;125(19):727-30
references.pmid: 16324465
references.citation: Drug Alcohol Depend. 2010 Dec 1;112(3):178-93
references.pmid: 20705402
references.citation: AIDS Behav. 2014 Oct;18 Suppl 5:S505-15
references.pmid: 23842717
references.citation: AIDS Care. 2010 Mar;22(3):355-60
references.pmid: 20390516
references.citation: J Int Assoc Physicians AIDS Care (Chic). 2010 Jul-Aug;9(4):218-26
references.pmid: 20798401
references.citation: Health Psychol. 2008 Sep;27(5):628-37
references.pmid: 18823189
references.citation: AIDS. 2012 Jan 14;26(2):185-92
references.pmid: 22179227
references.citation: AIDS Patient Care STDS. 2009 May;23(5):377-87
references.pmid: 19327098
references.citation: HIV Med. 2013 Nov;14(10):583-95
references.pmid: 23773654
references.citation: Int J Nurs Stud. 2009 Aug;46(8):1079-91
references.pmid: 19232614
references.citation: BMC Public Health. 2008 Feb 18;8:63
references.pmid: 18282286
references.citation: Curr HIV/AIDS Rep. 2012 Dec;9(4):287-312
references.pmid: 22936463
references.citation: J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):443-50
references.pmid: 18077833
references.citation: Addiction. 2014 Mar;109(3):394-406
references.pmid: 24304463
references.citation: AIDS Care. 2011 Jun;23(6):657-62
references.pmid: 21347887
references.citation: J Acquir Immune Defic Syndr. 2009 Oct 1;52(2):180-202
references.pmid: 19668086
references.citation: PLoS One. 2011;6(6):e20010
references.pmid: 21698283
references.citation: Addiction. 2009 May;104(5):705-15
references.pmid: 19413785
references.citation: J Assoc Nurses AIDS Care. 2012 Nov-Dec;23(6):511-20
references.pmid: 22421097
references.citation: J Int Assoc Physicians AIDS Care (Chic). 2010 Mar-Apr;9(2):98-103
references.pmid: 20207981
references.citation: Ann Pharmacother. 2011 Mar;45(3):372-9
references.pmid: 21386024
references.citation: BMC Public Health. 2012 Aug 30;12:716
references.pmid: 22935331
references.citation: Am J Orthopsychiatry. 2011 Jul;81(3):351-9
references.pmid: 21729015
references.citation: Ethiop Med J. 2006 Jul;44(3):237-44
references.pmid: 17447389
references.citation: PLoS Med. 2006 Nov;3(11):e438
references.pmid: 17121449
references.citation: AIDS Behav. 2012 Nov;16(8):2101-18
references.pmid: 22116638
references.citation: PLoS One. 2010 Oct 19;5(10):e13499
references.pmid: 20976068
references.citation: Glob J Health Sci. 2012 Sep 18;4(6):119-28
references.pmid: 23121748
references.citation: BMJ. 2003 Sep 6;327(7414):542-5
references.pmid: 12958116
references.citation: Alcohol Clin Exp Res. 2007 Feb;31(2):185-99
references.pmid: 17250609
references.citation: J Public Health Policy. 2011;32 Suppl 1:S52-64
references.pmid: 21730994
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD008063
references.pmid: 21563163
references.citation: AIDS Behav. 2010 Jun;14(3):669-78
references.pmid: 19967441
references.citation: Glob Public Health. 2011;6(1):83-97
references.pmid: 20509066
references.citation: Bull World Health Organ. 2009 Oct;87(10):754-62
references.pmid: 19876542
references.citation: Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1007-15
references.pmid: 19650153
references.citation: JAMA. 2006 Aug 9;296(6):679-90
references.pmid: 16896111