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      Alcohol reduction outcomes following brief counseling among adults with HIV in Zambia: A sequential mixed methods study

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          Abstract

          Data from sub-Saharan Africa on the impact of alcohol on the HIV epidemic in sub-Saharan Africa is limited. In this region, it is not well understood how people with HIV (PLWHA) respond to alcohol reduction counseling while they are linked to HIV clinical care. We conducted an explanatory sequential mixed-methods study to understand patterns of alcohol use among adults (18+ years) within a prospective HIV cohort at two urban public-sector clinics in Zambia. At antiretroviral therapy (ART) start and one year later, we measured alcohol use with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and those reporting any alcohol use were provided brief counseling. We conducted focus groups at 1 year with participants who had any alcohol use and 20 in-depth interviews among the subgroup with unhealthy use pre-ART and who either reduced or did not reduce their use by 1 year to moderate levels or abstinence. Focus group Discussions (FGDs) (n = 2) were also held with HIV clinic staff. Qualitative data were analyzed using thematic analysis. The data obtained from 693 participants was analyzed (median age 34 years, 45% men), it revealed that unhealthy alcohol use (AUDIT-C >3 for men; >2 for women) was reported among 280 (40.4%) at baseline and 205 (29.6%) at 1 year on ART. Reduction from unhealthy to moderate use or abstinence was more common with older age, female, non-smoking, and at Clinic B (all P<0.05). Qualitative data revealed ineffective alcohol support at clinics, social pressures in the community to consume alcohol, and unaddressed drivers of alcohol use including poverty, poor health status, depression, and HIV stigma. Healthcare workers reported a lack of training in alcohol screening and treatment, which led to mixed messages provided to patients (‘reduce to safe levels’ versus ‘abstain’). In summary, interventions to reduce unhealthy alcohol use are needed within HIV clinics in Zambia as a substantial population have persistent unhealthy use despite current HIV clinical care. A better understanding is needed regarding the implementation challenges related to screening for unhealthy alcohol use integrated with HIV services.

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          Using thematic analysis in psychology

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            The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

            To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.
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              Thematic networks: an analytic tool for qualitative research

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                Author and article information

                Contributors
                Role: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                25 May 2022
                2022
                : 2
                : 5
                : e0000240
                Affiliations
                [1 ] Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
                [2 ] School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
                [3 ] Department of Infectious Diseases and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
                [4 ] Columbia University Mailman School of Public Health, New York City, NY, United States of America
                [5 ] Bradford Institute for Health Research, Bradford, United Kingdom
                [6 ] School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
                Indian Council of Medical Research, INDIA
                Author notes

                The authors have declared that no competing interests exist. Authors Jenala Chipungu and Michael Vinikoor were unavailable to confirm their authorship contributions. On their behalf, the corresponding author has reported their contributions to the best of their knowledge.

                Author information
                https://orcid.org/0000-0002-7455-4255
                https://orcid.org/0000-0002-2177-756X
                https://orcid.org/0000-0002-8189-0732
                https://orcid.org/0000-0002-6598-3840
                https://orcid.org/0000-0002-7802-6206
                https://orcid.org/0000-0002-6252-3793
                https://orcid.org/0000-0002-3862-7795
                Article
                PGPH-D-21-00538
                10.1371/journal.pgph.0000240
                10021288
                36962202
                21d0687d-2024-4d0a-a257-129e0713bf86

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 20 August 2021
                : 2 February 2022
                Page count
                Figures: 1, Tables: 3, Pages: 16
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: U01AI069924
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000027, National Institute on Alcohol Abuse and Alcoholism;
                Award ID: K01AA026523
                Award Recipient :
                Funded by: Fogarty International Center at the United States National Institutes of Health
                Award ID: K01TW009998
                Award Recipient :
                Funded by: The Mary Fisher Foundation, the University of Alabama (UAB) Sparkman Center and Center for AIDS Research (CFAR)
                Award Recipient :
                This research was supported by the National Institute of Allergy and Infectious Diseases under grant number U01AI069924 (GW and MJV), the National Institute of Alcohol Abuse and Alcoholism under grant numbers K01AA026523 (JCK) and P01AA029540 (AS, JCK, and MJV), and the Fogarty International Center at the United States National Institutes of Health under grant number K01TW009998 (MJV). Additional support came from the University of Alabama (UAB) Center for AIDS Research P30 AI027767 (MJV) and Sparkman Center for Global Health (AH and JT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                Alcohol Consumption
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                To ensure adherence to Zambian research laws, data from this study are available only by request to the Centre for Infectious Disease Research in Zambia data analysis unit ( samuel.bosomprah@ 123456cidrz.org ).

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