AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #249 - Alcohol use as a predictor of antiretroviral therapy (ART) adherence, beyond structural and select psychosocial factors among South African adult ART recipients
Authors: Presenting Author: Dr Connie Kekwaletswe - Medical Research Council
Additional Authors: Dr. Neo Morojele, Ms. Sebenzile Nkosi,
Aim: Despite the detrimental consequences of poor adherence to ART, such as the development of resistant strains of HIV, non-adherence continues to be common. The role of alcohol use in non-adherence to antiretroviral therapy (ART) has not been as widely studied in sub-Saharan Africa as has the role of structural factors (e.g. difficulty getting to ART sites, due to health centres being far from patients’ residences) and psychosocial factors (e.g. stigma and serostatus disclosure) in non-adherence to ART. However, it is not clear whether alcohol use plays an independent role in non-adherence to ART relative to structural and psychosocial factors. The objective of this study was to determine whether alcohol use predicts ART adherence over and beyond structural and psychosocial factors.
Method / Issue: We recruited 304 male and female ART recipients using purposive sampling, from two ART sites in Tshwane, South Africa. The participants took part in face-to-face interviews at the clinics. The dependent variable was adherence to ART, as assessed by the 3-item CASE Adherence Index (which assesses 3 distinct aspects of adherence). The independent variables were demographic factors (age, gender, marital status, education and employment), structural factors (housing instability, time spent getting to the doctor’s office, perceived difficulty in getting to the ART site, food insecurity, and material/resource poverty), psychosocial factors (stigma and serostatus disclosure) and alcohol use (as measured by the AUDIT score). Data were analysed using hierarchical multiple regression, in which demographic, structural, psychosocial factors and alcohol use were entered in 4 steps, respectively.
Results / Comments: Demographic variables, entered at Step 1, explained 4% of the variance in ART adherence. The total variance explained after entering structural variables (Step 2) was 13%, F (10, 271)= 4.02, p<0.001. The structural variables accounted for 9% of the variance explained in ART adherence; R2-change =0.089, F change (5, 271)= 5.52, p<0.001. The total variance explained by the model after entering psychosocial variables (Step 3) was 18%, F (12, 269)=5.01, p<0.001. Psychosocial variables accounted for 5% of the variance explained in ART adherence; R2-change= 0.053, F change (2, 269)= 8.77, p<0.001. The AUDIT variable was entered at Step 4, after which the cumulative model explained 26% of the variance in ART adherence, F (13, 268)= 7.32, p<0.001. AUDIT score accounted for 8% of the variance explained in ART adherence; R2-change= 0.079, F change (1, 268) =28.85. In the overall model, neither the demographic variables nor 3 out of the 5 structural variables (material/resource poverty, current living situation and difficulty to pick up ART) were significant.
Discussion: Alcohol use was a unique and significant predictor of ART adherence over and beyond demographic, structural and psychosocial variables. In addition to addressing psychosocial factors such as stigma and serostatus disclosure, public health programs would further enhance ART adherence by also investing resources in the treatment of problem alcohol use.
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