title: Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa.
abstract: Alcohol use during pregnancy is prevalent in South Africa, but there are few prospectively-collected data exploring patterns of consumption among HIV-infected women, which may be important to improve maternal and child health outcomes. We examined patterns of and factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa.
  
  
  
  Participants were enrolled when entering antenatal care at a large primary care clinic, and alcohol use was assessed using the AUDIT (Alcohol Use Disorders Identification Test). In analysis, the AUDIT-C scoring was used as a measure of hazardous drinking, and we examined factors associated with patterns of alcohol use in logistic regression models.
  
  
  
  Among 580 women (median age: 28.1 years), 40% reported alcohol use during the 12 months prior to pregnancy, with alcohol use characterised by binge drinking and associated with single relationship status, experience of intimate partner violence (IPV), and lower levels of HIV-related stigma. Of this group, 65% had AUDIT-C scores suggesting hazardous alcohol use, with hazardous alcohol users more likely to report having experienced IPV and having higher levels of education. Among hazardous alcohol users, 70% subsequently reported reduced levels of consumption during pregnancy. Factors independently associated with reduced consumption included earlier gestation when entering antenatal care and report of a better patient-healthcare provider relationship.
  
  
  
  These unique data provide important insights into alcohol use trajectories in this context, and highlight the urgent need for an increased focus on screening and intervention at primary care level.
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa. Electronic address: kirsty.brittain@uct.ac.za.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Brittain
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Phillips
authors.affiliation: ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Zerbe
authors.affiliation: ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA; College of Physicians & Surgeons, Columbia University, New York, NY, USA.
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
authors.forename: Claude A
authors.initials: CA
authors.lastname: Mellins
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011320:Primary Health Care; D012307:Risk Factors; D012931:Social Environment; D057545:Social Stigma; D013019:South Africa; D013179:Spouse Abuse / Q000523:psychology*; D055815:Young Adult
keywords: Alcohol; HIV; Pregnancy; South Africa