title: The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: Event-level findings from a daily diary study.
abstract: Using daily diary methods, we aimed to test the hypothesis that at the event-level consuming alcohol increases the likelihood that antiretrovirals (ARV) will be missed on a particular day.
  
  
  
  This prospective cohort study of 74 (52 female, 22 male) people living with HIV (PLHIV) in South Africa collected event-level data on ARV adherence and alcohol consumption using structured daily phone interviews over a period of 42days generating 2718 data points. We used generalized estimating equations (GEE) analyses to assess univariate and multivariate associations between alcohol and adherence, controlling for sociodemographics and testing for effect modification.
  
  
  
  Controlling for sociodemographics, each alcohol measure was a statistically significant predictor of non-adherence on a particular day; any drinking compared to no drinking (daytime: AOR=3.18, 95% CI=2.25-4.49; evening: AOR=3.43, 95% CI=2.12-5.53), consuming more alcohol than one normally consumes (daytime: AOR=1.06, 95% CI=1.02-1.11; evening: AOR=1.10, 95% CI=1.05-1.15), and drinking at low to moderate risk level (daytime: 4.29, 95% CI=2.81-6.56; evening: AOR=4.24, 95% CI=2.38-7.54) and high to very high risk levels (daytime: AOR=2.31, 95% CI=1.56-3.42; evening: AOR=3.08, 95% CI=1.91-4.98) were all significantly related to missing ARVs in the daytime and evening.
  
  
  
  These data provide support for an event-level relationship between alcohol and non-adherence. Interventions that mitigate alcohol use among people on ARVs or provide strategies to maintain optimal adherence among those who drink are needed.
authors: Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, United States.
authors: Katelyn M
authors: KM
authors: Sileo
authors: Human Sciences Research Council, Cape Town, South Africa; Department of Psychiatry & Mental Health, University of Cape Town, South Africa.
authors: Leickness C
authors: LC
authors: Simbayi
authors: Cochrane South Africa, South African Medical Research Council, School of Anthropology and Conservation, University of Kent, South Africa.
authors: Amber
authors: A
authors: Abrams
authors: Human Sciences Research Council, Cape Town, South Africa.
authors: Allanise
authors: A
authors: Cloete
authors: Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, United States. Electronic address: skiene@mail.sdsu.edu.
authors: Susan M
authors: SM
authors: Kiene
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000523:psychology*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D013019:South Africa; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART; Adherence; Alcohol; Event-level analysis; HIV/AIDS; South Africa