title: Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report.
abstract: OBJECTIVE
  We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone.
  
  
  METHODS
  A prospective 1-year observational cohort study with quarterly visits.
  
  
  METHODS
  Large rural HIV clinic in Mbarara, Uganda.
  
  
  METHODS
  A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption.
  
  
  METHODS
  Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use.
  
  
  RESULTS
  The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively.
  
  
  CONCLUSIONS
  Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
authors.affiliation: University of California, Department of Medicine, San Francisco, CA, USA.|University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
authors.forename: Judith A
authors.identifier: http://orcid.org/0000-0002-2697-8264
authors.initials: JA
authors.lastname: Hahn
authors.affiliation: University of California, Department of Medicine, San Francisco, CA, USA.
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Emenyonu
authors.affiliation: University of California, Department of Medicine, San Francisco, CA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Fatch
authors.affiliation: Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda.
authors.forename: Winnie R
authors.initials: WR
authors.lastname: Muyindike
authors.affiliation: Mbarara University of Sciences and Technology, Faculty of Medicine, Mbarara, Uganda.
authors.forename: Allen
authors.initials: A
authors.lastname: Kekiibina
authors.affiliation: University of California, Department of Community Health Systems, San Francisco, CA, USA.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.affiliation: University of California, Department of Medicine, San Francisco, CA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Woolf-King
authors.affiliation: University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000553:Ambulatory Care; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D005260:Female; D020404:Glycerophospholipids / Q000378:metabolism; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012423:Rural Health; D057566:Self Report; D014454:Uganda / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol
keywords: Africa; HIV; Uganda; biomarker; brief intervention; phosphatidylethanol; self-report; trend; unhealthy alcohol use