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Prevalence and determinants of alcohol use among adults living with HIV/AIDS in Ethiopia: a systematic review protocol.

ABSTRACT: BACKGROUND:Alcohol use is a challenging problem which attributes to more than 5% of the overall global burden of disease. It is more common among persons with HIV infection than the general population. Although there are separate studies regarding people with HIV/AIDS in Ethiopia, their results are highly variable and discrepant. The objectives of this study will be to evaluate the prevalence of alcohol use and to identify its associated factors among people with HIV/AIDS in Ethiopia. METHODS:A systematic search of electronic databases (from inception onwards) of PubMed/MEDLINE, Embase, PsycINFO, and Cochrane Library will be conducted. Moreover, grey literatures will be searched from different sources (such as Google Scholar, OpenGrey, and World Health Organization websites). Reference lists of the selected articles will also be searched manually. Observational studies (cross-sectional, case-control, cohort) reporting the prevalence of alcohol use and/or its associated factors among adults with HIV/AIDS in Ethiopia will be included. The primary outcomes will be the prevalence of alcohol use among HIV/AIDS population. Secondary outcomes will be the determinants of alcohol use described in the included studies. Two reviewers will independently screen all citations and full-text articles and extract data. The studies' methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis of observational data. Heterogeneity of primary studies will be assessed using the I2 test. Prevalence estimates will be stratified according to gender, age, and geographical location. Small-study effects (publication bias) also will be examined. DISCUSSION:Our systematic review and meta-analysis will prevail the pooled prevalence of alcohol use and its determinants among people with HIV/AIDS in Ethiopia. The finding of this study will be helpful to design appropriate preventive and interventional strategies for alcohol use among people with HIV/AIDS. This can have direct or indirect policy responses and clinical implications. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019132524.

SUBMITTER: Mekuriaw B

PROVIDER: S-EPMC7282110 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Prevalence and determinants of alcohol use among adults living with HIV/AIDS in Ethiopia: a systematic review protocol.

Mekuriaw Birhanie B Belayneh Zelalem Z Molla Alemayehu A Mehare Tsegaye T

Systematic reviews 20200608 1

<h4>Background</h4>Alcohol use is a challenging problem which attributes to more than 5% of the overall global burden of disease. It is more common among persons with HIV infection than the general population. Although there are separate studies regarding people with HIV/AIDS in Ethiopia, their results are highly variable and discrepant. The objectives of this study will be to evaluate the prevalence of alcohol use and to identify its associated factors among people with HIV/AIDS in Ethiopia.<h4 ...[more]

PMID: 32513267

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Project description:BackgroundAlcohol use is a common practice of almost all communities worldwide and it is more common among persons with HIV infection. Alcohol consumption among people with HIV/AIDS may result in poor treatment adherence, further immunity suppression and increase the risk of comorbid illness (diseases) which collectively diminish the anti-retroviral therapy responses. Although there are separate studies conducted regarding alcohol use among people with HIV/AIDS in Ethiopia, the finding results are highly variable and inconsistent. Therefore, conducting a systematic review and meta-analysis has a paramount importance to show the pooled prevalence of alcohol use and to identify its determinants among people with HIV/AIDS.MethodsA systematic search of electronic databases of PubMed/Medline, Science Direct, Hinnari and Cochrane library was employed. Additionally, the grey literature was searched from Google and Google Scholar. Data were extracted using a standardized data extraction format prepared in Microsoft Excel . STATA-version 14 statistical software was used for analysis. Heterogeneity of primary studies was found as evaluated using the I2 test result. As a result, a random-effect meta-analysis model was used to estimate the pooled prevalence of alcohol use.ResultsA total of 22 primary studies which comprises 8,368 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime, current and hazardous alcohol use among HIV patients in Ethiopia were 36.42% [95% CI (19.96, 52.89)], 19.00% [95% CI (12.98, 25.01)] and 21.64% [95% CI (12.72, 30.55)], respectively. Khat chewing [OR = 3.53, (95% CI 1.31, 9.51)] and cigarette smoking [OR = 7.04, (95% CI 3.53, 14.04)] were found as statistically significant determinants of hazardous alcohol use among people with HIV infection.ConclusionsThe result of this review showed that alcohol drinking is highly practiced among people with HIV/AIDS in Ethiopia. The magnitude of alcohol use was highly variable based on the screening methods used to measure alcohol use. Comorbid substance use (khat and cigarette) increases the risk of alcohol consumption among HIV patients. This suggests a need for designing appropriate and culturally applicable intervention programs and policy responses. Trial registration PROSPERO 2019, "CRD42019132524."

Project description:BACKGROUND:Alcohol use disorder (AUD) is common among people living with HIV/AIDS (PLWHA) and associated with a greater risk of poor medication adherence, unsafe sexual behaviors as well as poor quality of life. To our knowledge, there is no previous systematic review and meta-analysis that reported the pooled prevalence estimate of AUD among PLWHA. Therefore, this review aimed to systematically review the available studies on the prevalence of AUD among PLWHA and forward possible recommendations for future clinical practice and research. METHODS:PubMed, EMBASE, Psych INFO and SCOPUS databases were searched to identify the relevant studies. We have also scanned the reference lists of the eligible studies to supplement our electronic search. We used the Comprehensive Meta-Analysis software versions 3.0 to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q- and the I2- test were employed to see the heterogeneity. The presence of publication bias was explored by utilizing Egger's test and visual inspection of the symmetry in funnel plots. RESULTS:A total of 25 studies with 25,154 participants across developed and developing countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence estimate of AUD among PLWHA was found to be 29.80% (95% CI; 24.10-35.76). The prevalence of AUD was higher in males (26.90%) than female (13.37%) HIV patients. In this study, the pooled prevalence of AUD was considerably higher (31.52%) when measured by Alcohol Use Disorders Identification Test (AUDIT) as compared to Composite International Diagnostic Interview (CIDI) (13.51%). In addition, the pooled prevalence of AUD was higher in the developed countries (42.09%) while lower for developing countries (24.52%). CONCLUSION:In the current study, the pooled prevalence estimates of AUD among PLWHA was considerably high (29.80%). Screening and appropriate management of AUD among PLWHA are recommended.

Project description:Antiretroviral therapy (ART) is efficacious in improving clinical outcomes among people living with HIV (PLWH) and reducing HIV transmission when taken regularly. Research examining modifiable factors associated with ART non-adherence is critical for informing novel intervention development in settings with high HIV prevalence. Alcohol use has been linked with ART non-adherence in studies in sub-Saharan Africa; however, no review has pooled estimates across studies. We reviewed studies of alcohol use and ART non-adherence conducted in sub-Saharan Africa. We searched PubMed, CINAHL, EMBASE, and PsycINFO through August 2019 with terms related to ART non-adherence, alcohol use, and sub-Saharan Africa. One author reviewed titles/abstracts (n = 754) and two authors reviewed full texts (n = 308) for inclusion. Discrepancies were resolved by group consensus. Studies were retained if they quantitatively measured associations between alcohol use and ART non-adherence or viral non-suppression. We defined ART non-adherence using the definitions from each parent study (e.g., patients with > 5% missed ART doses during the previous four, seven or 30 days were considered non-adherent). A random effects meta-analysis was conducted to pool associations and we conducted additional analyses to assess between-study heterogeneity and publication bias and sensitivity analyses to determine robustness of our results when considering only certain study designs, alcohol use or ART scales, or studies that used viral non-suppression as their primary outcome. Of 56 articles meeting our inclusion criteria, 32 articles were included in the meta-analysis. All studies measured alcohol use via self-report. ART non-adherence was assessed using self-report, pill counts, or pharmacy records and definition of non-adherence varied depending on the measure used. Individuals who used alcohol had twice the odds of ART non-adherence compared with those who did not use alcohol (34% non-adherence among alcohol users vs. 18% among non-users; pooled odds ratio: 2.25; 95% confidence interval: 1.87-2.69; p < 0.001). We found evidence of a high degree of heterogeneity between studies (Cochrane Q statistic: 382.84, p< 0.001; I2 proportion: 91.9%) and evidence of publication bias. However, the magnitude of our pooled odds ratio was consistent across a number of sensitivity analyses to account for heterogeneity and publication bias. In a secondary analysis with studies using viral non-suppression as their primary outcome, we also estimated a statistically significant pooled effect of alcohol use on viral non-suppression (pooled odds ratio: 2.47; 95% confidence interval: 1.58-3.87). Evidence suggests alcohol use is associated with ART non-adherence in Sub-Saharan Africa, potentially hindering achievement of the UNAIDS 90-90-90 HIV treatment targets.

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Prevalence and determinants of alcohol use among adults living with HIV/AIDS in Ethiopia: a systematic review protocol.

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Prevalence and determinants of alcohol use among adults living with HIV/AIDS in Ethiopia: a systematic review protocol.

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