Heavy alcohol use and the HIV care continuum in Kenya: a population-based study

ABSTRACT

Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15–64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8–11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14–6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25–6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85–5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum.

KEYWORDS:

• HIV treatment
• binge drinking
• antiretroviral therapy
• people living with HIV
• population-based HIV impact assessment
• sub-Saharan Africa

Acknowledgements

We thank all KENPHIA participants for sharing their time and their bodies in advancement of HIV science. We extend our gratitude to the survey enumerators and study managers, without whom this study would not be possible. Finally, we acknowledge all the organizations who supported the implementation of KENPHIA, specifically the Kenya Council of Governors, the Association of People Living with HIV/AIDS in Kenya, Westat, the U.S. Centers for Disease Control and Prevention, ICAP at Columbia University, and the Kenya Ministries of Health, Devolution and Planning, and Interior and Coordination of National Government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are available for public use and can be requested from: https://phia-data.icap.columbia.edu/datasets.

Author contributions

JGR conceptualized the analysis. EW managed and analyzed data, with oversight and supervision from JGR. EW prepared the first draft of the manuscript, with input from JGR. All authors contributed to and approved the final version of the manuscript submitted for publication.

Disclaimer

The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, PEPFAR, NIH, or the U.S. Government.

Additional information

Funding

This work was supported by U.S. Centers for Disease Control and Prevention (CDC), via the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), under cooperative agreements U2GGH001271 and U2GGH001226. JGR was supported by the National Institute of Mental Health (F31MH126796, R25MH083620).