title: Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda.
abstract: Under-reporting of alcohol use by HIV-infected patients could adversely impact clinical care. This study examined factors associated with under-reporting of alcohol consumption by patients who denied alcohol use in clinical and research settings using an alcohol biomarker. We enrolled ART-naïve, HIV-infected adults at Mbarara Hospital HIV clinic in Uganda. We conducted baseline interviews on alcohol use, demographics, Spirituality and Religiosity Index (SRI), health and functional status; and tested for breath alcohol content and collected blood for phosphatidylethanol (PEth), a sensitive and specific biomarker of alcohol use. We determined PEth status among participants who denied alcohol consumption to clinic counselors (Group 1, n = 104), and those who denied alcohol use on their research interview (Group 2, n = 198). A positive PEth was defined as ≥8 ng/ml. Multiple logistic regression models were used to examine whether testing PEth-positive varied by demographics, literacy, spirituality, socially desirable reporting and physical health status. Results showed that, among the 104 participants in Group 1, 28.8% were PEth-positive. The odds of being PEth-positive were higher for those reporting prior unhealthy drinking (adjusted odds ratio (AOR): 4.7, 95% confidence interval (CI): 1.8, 12.5). No other factors were statistically significant. Among the 198 participants in Group 2, 13.1% were PEth-positive. The odds of being PEth-positive were higher for those reporting past unhealthy drinking (AOR: 4.6, 95% CI: 1.8, 12.2), the Catholics (AOR: 3.8, 95% CI: 1.3, 11.0) compared to Protestants and lower for the literate participants (AOR: 0.3, 95% CI: 0.1, 0.8). We concluded that under-reporting of alcohol use to HIV clinic staff was substantial, but it was lower in a research setting that conducted testing for breath alcohol and PEth. A report of past unhealthy drinking may highlight current alcohol use among deniers. Strategies to improve alcohol self-report are needed within HIV care settings in Uganda.
authors.affiliation: a Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda.|b Department of Medicine , Mbarara Regional Referral Hospital , Mbarara , Uganda.
authors.forename: Winnie R
authors.initials: WR
authors.lastname: Muyindike
authors.affiliation: c Data Coordinating Center, Boston University School of Public Health , Boston , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.affiliation: d Department of Medicine , University of California , San Francisco , USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Fatch
authors.affiliation: d Department of Medicine , University of California , San Francisco , USA.
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Emenyonu
authors.affiliation: a Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda.
authors.forename: Julian
authors.initials: J
authors.lastname: Adong
authors.affiliation: e MUST Grants Office, Mbarara University of Science and Technology , Mbarara , Uganda.
authors.forename: Christine
authors.initials: C
authors.lastname: Ngabirano
authors.affiliation: f Department of Biostatistics , Boston University School of Public Health , Boston , USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: c Data Coordinating Center, Boston University School of Public Health , Boston , USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.affiliation: g Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, Boston Medical Center , Boston , USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: d Department of Medicine , University of California , San Francisco , USA.|h Department of Epidemiology and Biostatistics , University of California , San Francisco , USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D005260:Female; D020404:Glycerophospholipids / Q000097:blood; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012423:Rural Health; D012424:Rural Population; D057566:Self Report; D014454:Uganda; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol
keywords: Alcohol consumption; HIV; Uganda; phosphatidylethanol; under-report