title: Comparison of self-reported alcohol consumption to phosphatidylethanol measurement among HIV-infected patients initiating antiretroviral treatment in southwestern Uganda.
abstract: BACKGROUND
  Alcohol consumption among HIV-infected patients may accelerate HIV disease progression or reduce antiretroviral therapy adherence. Self-reported alcohol use is frequently under-reported due to social desirability and recall bias. The aim of this study was to compare self-reported alcohol consumption to phosphatidylethanol (PEth), a biomarker of alcohol consumption, and to estimate the correlation between multiple measures of self-reported alcohol consumption with PEth.
  
  
  METHODS
  The Uganda AIDS Rural Treatment Outcomes (UARTO) cohort is located in southwestern Uganda and follows patients on ART to measure treatment outcomes. Patients complete standardized questionnaires quarterly including questions on demographics, health status and alcohol consumption. Baseline dried blood spots (DBS) were collected and retrieved to measure PEth.
  
  
  RESULTS
  One hundred fifty samples were tested, and 56 (37.3%) were PEth positive (≥8 ng/mL). Of those, 51.7% did not report alcohol use in the past month. Men were more likely to under-report compared to women, OR 2.9, 95% CI = 1.26, 6.65) and those in the higher economic asset categories were less likely to under-report compared to those in the lowest category (OR = 0.41 95% CI: 0.17, 0.94). Among self-reported drinkers (n = 31), PEth was highly correlated with the total number of drinking days in the last 30 (Spearman R = 0.73, p<0.001).
  
  
  CONCLUSIONS
  Approximately half of HIV infected patients initiating ART and consuming alcohol under-report their use of alcohol. Given the high prevalence, clinicians should assess all patients for alcohol use with more attention to males and those in lower economic asset categories who deny alcohol use. Among those reporting current drinking, self-reported drinking days is a useful quantitative measure.
authors.affiliation: Mbarara University of Science and Technology, Faculty of Medicine, Department of Community Health, P.O. Box 1410, Mbarara, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.affiliation: Epicentre Uganda Research Center, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Hunt
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Rain
authors.initials: R
authors.lastname: Mocello
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America; Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America; Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D020404:Glycerophospholipids / Q000097:blood*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D020404:Glycerophospholipids; C051521:phosphatidylethanol