title: Binge drinking is associated with differences in weekday and weekend adherence in HIV-infected individuals.
abstract: BACKGROUND
  Understanding patterns of antiretroviral adherence and its predictors is important for designing tailored interventions. Alcohol use is associated with non-adherence. This study aimed to evaluate: (1) if there was a difference in weekday compared with weekend adherence in HIV-infected individuals from low and middle income countries (LMIC), and (2) whether binge drinking was associated with this difference.
  
  
  METHODS
  Data from a randomized trial conducted at 9 sites in 8 LMIC were analyzed. Microelectronic monitors were used to measure adherence. Differences between weekday and weekend adherence in each quarter (successive 12-week periods) were compared using Wilcoxon signed rank tests and predictors of adherence, including baseline binge drinking, were evaluated using Generalized Estimating Equations.
  
  
  RESULTS
  Data from 255 participants were analyzed: 49.8% were male, median age was 37 years and 28.6% enrolled in Haiti. At study entry, only 2.7% reported illicit substance use, but 22.3% reported binge drinking at least once in the 30 days prior to enrollment. Adherence was higher on weekdays than weekends (median percent doses taken: 96.0% vs 94.4%; 93.7% vs 91.7%; 92.6% vs 89.7% and 93.7% vs 89.7% in quarters 1-4 respectively, all p<0.001). Binge drinking at baseline and time on study were both associated with greater differences between weekday and weekend adherence.
  
  
  CONCLUSIONS
  Adherence was worse on weekends compared to weekdays: difference was small at treatment initiation, increased over time and was associated with binge drinking. Screening and new interventions to address binge drinking, a potentially modifiable behavior, may improve adherence in HIV-infected individuals in LMIC.
authors.affiliation: Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA; Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil. Electronic address: raqueldeboni@gmail.com.
authors.forename: Raquel B
authors.initials: RB
authors.lastname: De Boni
authors.affiliation: Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA.
authors.forename: Lu
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Rosenkranz
authors.affiliation: Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lavenberg
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Cardoso
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Asociacion Civil Impacta Salud y Educacion, Lima, Peru.
authors.forename: Alberto
authors.initials: A
authors.lastname: La Rosa
authors.affiliation: Institut National de Laboratoire et de Recherches, Centres Gheskio, Port au Prince, Haiti.
authors.forename: Samuel
authors.initials: S
authors.lastname: Pierre
authors.affiliation: Institut National de Laboratoire et de Recherches, Centres Gheskio, Port au Prince, Haiti.
authors.forename: Patrice
authors.initials: P
authors.lastname: Severe
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Cohn
authors.affiliation: Harborview Medical Center, University of Washington, Seattle, WA, USA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Collier
authors.affiliation: Department of Medicine (Infectious Diseases) and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D063425:Binge Drinking / Q000150:complications* / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007182:Income; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Adherence; Alcohol; Binge drinking; HIV/AIDS; Low and middle income countries; Microelectronic monitors