Randomized Study of Assessment Effects on Alcohol Use by Persons With HIV in Rural Uganda.
Unhealthy alcohol use is a crucial driver of HIV in sub-Saharan Africa, and interventions are needed. The goal of this study was to assess whether assessment itself (assessment reactivity) causes declines in alcohol use in a research study in persons with HIV in Uganda.



Study participants were adult patients of the Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda, who were new to HIV care and reported any alcohol consumption in the prior year. Participants were randomized to (a) a study cohort, with structured interviews, breath alcohol analysis tests, and blood draws conducted quarterly, or (b) a minimally assessed arm that engaged in these procedures only once, at 6 months after baseline. The main outcome was unhealthy drinking at 6 months, defined as Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] positive (≥3 for women, ≥4 for men) or phosphatidylethanol (PEth; an alcohol biomarker) level ≥ 50 ng/ml. We also examined this outcome stratified by gender.



We examined 175 and 139 persons in the quarterly assessed versus minimally assessed arms, respectively. Overall, 54.8% were male, the median age was 30 (interquartile range: 25-36), and 58.0% initiated anti-retroviral therapy at 6 months. Nearly equal proportions (53.7% and 51.1% in the study quarterly assessed vs. minimally assessed arm, respectively) engaged in unhealthy drinking in the 3 months before the 6-month study visit (p = .64), and we found no evidence of interaction by gender (p = .36).



We found no evidence of assessment reactivity in a study that included quarterly study visits. Assessment is not sufficient to act as an intervention itself in this population with high levels of unhealthy drinking. Interventions are needed to decrease alcohol consumption in this population.
Department of Medicine, University of California, San Francisco, San Francisco, California, United States.
Nneka I
NI
Emenyonu
Department of Medicine, University of California, San Francisco, San Francisco, California, United States.
Robin
R
Fatch
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.|Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
Winnie R
WR
Muyindike
Mbarara University of Science and Technology Grants Office, Mbarara, Uganda.
Allen
A
Kekibiina
Department of Medicine, University of California, San Francisco, San Francisco, California, United States.|Deparment of Psychology, Syracuse University, Syracuse, New York, United States.
Sarah
S
Woolf-King
Department of Medicine, University of California, San Francisco, San Francisco, California, United States.|Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States.
Judith A
JA
Hahn
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D020404:Glycerophospholipids / Q000032:analysis; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol