The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: Event-level findings from a daily diary study

- All alcohol variables were associated with missed antiretrovirals at the event-level.
- The largest effect was at a low-moderate level compared to no drinking.
- This finding remained controlling for each person's normal alcohol consumption.

ObjectiveUsing daily diary methods, we aimed to test the hypothesis that at the event-level consuming alcohol increases the likelihood that antiretrovirals (ARV) will be missed on a particular day.MethodsThis prospective cohort study of 74 (52 female, 22 male) people living with HIV (PLHIV) in South Africa collected event-level data on ARV adherence and alcohol consumption using structured daily phone interviews over a period of 42 days generating 2718 data points. We used generalized estimating equations (GEE) analyses to assess univariate and multivariate associations between alcohol and adherence, controlling for sociodemographics and testing for effect modification.ResultsControlling for sociodemographics, each alcohol measure was a statistically significant predictor of non-adherence on a particular day; any drinking compared to no drinking (daytime: AOR = 3.18, 95% CI = 2.25-4.49; evening: AOR = 3.43, 95% CI = 2.12-5.53), consuming more alcohol than one normally consumes (daytime: AOR = 1.06, 95% CI = 1.02-1.11; evening: AOR = 1.10, 95% CI = 1.05-1.15), and drinking at low to moderate risk level (daytime: 4.29, 95% CI = 2.81-6.56; evening: AOR = 4.24, 95% CI = 2.38-7.54) and high to very high risk levels (daytime: AOR = 2.31, 95% CI = 1.56-3.42; evening: AOR = 3.08, 95% CI = 1.91-4.98) were all significantly related to missing ARVs in the daytime and evening.ConclusionsThese data provide support for an event-level relationship between alcohol and non-adherence. Interventions that mitigate alcohol use among people on ARVs or provide strategies to maintain optimal adherence among those who drink are needed.