title: The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi.
abstract: Female sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi.
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.|b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Lancaster
authors.affiliation: c UNC Project Malawi, University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Thandie
authors.initials: T
authors.lastname: Lungu
authors.affiliation: c UNC Project Malawi, University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Pearson
authors.initials: P
authors.lastname: Mmodzi
authors.affiliation: b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.|c UNC Project Malawi, University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: d Theatre for a Change , Lilongwe , Malawi.
authors.forename: Katy
authors.initials: K
authors.lastname: Chadwick
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: e Department of Health Behavior , Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Vivian F
authors.initials: VF
authors.lastname: Go
authors.affiliation: b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.|c UNC Project Malawi, University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.affiliation: a Department of Epidemiology , Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.|c UNC Project Malawi, University of North Carolina at Chapel Hill , Lilongwe , Malawi.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D015995:Prevalence; D060386:Sex Workers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: FSW; alcohol; antiretroviral therapy; marijuana; viral suppression