Intersection of alcohol use, HIV infection, and the HIV care continuum in Zambia: nationally representative survey

ABSTRACT

Through a nationally-representative household survey, we measured the prevalence and correlates of unhealthy alcohol use (UAU) in Zambia and its association with the HIV care continuum. Adolescent and adult (ages 15–59 years) data, including the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), from the 2016 Zambia Population-based HIV Impact Assessment, were analyzed. UAU was defined as AUDIT-C of 3 + points for women and 4 + for men. Among 20,923 participants, 15.3% had UAU; this was 21.6% among people living with HIV (PLWH). Male sex, increasing age, being employed, urban residence, and having HIV were independent correlates of UAU (all P < 0.05). Among PLWH, UAU was associated with reduced HIV diagnosis (adjusted odds ratio [AOR]: 0.66, 95% CI 0.50–0.88) and non-significant trends toward reduced ART use if diagnosed (AOR: 0.73, 95% CI 0.73–1.10) and reduced viral suppression (VS) if on ART (AOR: 0.91, 95% CI 0.57–1.44). Overall, UAU was linked to 25% lower odds of VS compared to abstinence. UAU in Zambia disproportionately affects certain groups including PLWH. Achieving and sustaining HIV epidemic control in Zambia will require evidence-based approaches to screen and treat UAU.

KEYWORDS:

• Unhealthy alcohol use
• HIV/AIDS
• sub-Saharan Africa
• HIV care continuum
• alcohol use disorders identification test

Disclosure statement

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

Data availability statement

The data used for this manuscript are publically-available and can be requested via the following link: https://phia.icap.columbia.edu/countries/zambia/.

Additional information

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (Grants K01AA026523, R34AA027200, and P01AA029540) and the National Institute of Mental Health (Grant R01MH115495) at U.S. National Institiutes of Health].