Barcelona 2013
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| Abstract #516 - Drugs and Alcohol | ||||
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Session: 22.5: Drugs and Alcohol (Parallel) on Monday @ 16.30-18.30 in Mirador Chaired by Sam Friedman, Rosa Mansilla Authors: Presenting Author: Dr Connie Kekwaletswe - Medical Research Council of South Africa, South Africa |
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| Additional Authors: Dr. Patricia Solomon, Mr. Larry Baxter, Dr. Alan Casey, Mr. Will Chegwidden, Mr. Duncan MacLachlan, Dr. Joy MacDermid, Ms. Anne-Marie Tynan, Dr. Greg Robinson, Dr. Barry Trentham, Ms. Janet Wu, Ms. Elisse Zack, | ||||
| Aim: Optimal ART adherence is one of the predictors of good clinical outcomes like suppressed viremia and decreased mortality, and alcohol use has been cited as one of the modifiable psychosocial factors which hamper ART adherence (Hendershot et al., 2009; Nakimuli-Mpungu et al., 2011). Two patterns of taking ART among alcohol drinkers have been identified in the literature thus far: skipping and not skipping ART when drinking alcohol (Kalichman et al., 2009; 2012). Based on our prior formative research (Kekwaletswe et al., 2010), we identified three patterns of medication taking among alcohol drinkers: taking ART earlier than the prescribed dosing time when planning to drink alcohol, skipping ART doses when drinking alcohol and taking ART concurrent with alcohol or after drinking alcohol. The aim of this study is to extend this line of research by evaluating: (1) patterns of ART taking and (2) predictors of the patterns of ART taking among alcohol drinkers. | ||||
| Method / Issue: Using purposive sampling, we recruited 304 male and female patients from two ART clinics in Tshwane, South Africa; one in a city and the other in a township. Interviews were conducted using a structured questionnaire. Among other variables, the structured questionnaire consisted of measures of demographic factors (i.e. age, gender, education, assets), psychosocial factors (i.e. ART adherence self-efficacy beliefs, interactive toxicity beliefs, ART-alcohol outcome expectancy beliefs, attitude towards drinking alcohol and taking ART, stigma), and alcohol use (as measured by the AUDIT). Data were analysed using descriptive statistics and three multiple linear regressions were conducted to determine the predictors of each of the ART taking patterns. | ||||
| Results / Comments: Less than half (40%) of the sample reported drinking alcohol. Half of those who drink alcohol endorsed a single/unique pattern of taking ART. The other half endorsed combinations of ART taking patterns. Early ART dosing and taking ART concurrent with alcohol was the most common pattern. High adherence perseverance (a subscale of the adherence self-efficacy measure) and a non-favourable attitude towards drinking alcohol and taking ART predicted the unique pattern of taking ART early when planning to drink alcohol [ F (2,116) = 5.42; p = 0.006; R2= 0.09]. A high score on the alcohol measure (AUDIT) and experience of high stigma predicted the unique pattern of skipping ART doses when drinking alcohol [ F (2,115) = 7.33; p = 0.001; R2= 0.11]. On the other hand, a high level of education, high socioeconomic status (as measured by the asset score) and low experience of stigma predicted the unique pattern of taking ART concurrent with drinking alcohol [F(3,115) = 4.01; p = 0.009; R2= 0.10]. | ||||
| Discussion: Patterns of ART taking in alcohol drinkers in this sample are varied, and in some patients they are not mutually exclusive. This apparent complexity of medication taking patterns among alcohol drinkers warrants further exploration. Furthermore, different psychosocial factors predict different ART taking patterns, which implies that programs to improve alcohol-related non-adherence to ART ought to be multifaceted. | ||||
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