Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression.

Jessica F Magidson, Hari S Iyer, Kristen S Regenauer, David J Grelotti, Janan J Dietrich, Ingrid Courtney, Gugu Tshabalala, Catherine Orrell, Glenda E Gray, David R Bangsberg, Ingrid T Katz

Journal: Drug and alcohol dependence 2019;198():192-198

PMID: 30953938

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Abstract

BACKGROUND

South Africa has the highest number of people living with HIV (PLWH) and one of the largest antiretroviral therapy (ART) programs globally. High rates of substance use comorbidity exist, including speculation of recreational ART use (i.e., mixing ART with other illicit drugs). Recreational ART use may affect viral load among PLWH due to ART nonadherence and/or viral resistance; however, prior quantitative research has not examined rates of recreational ART use, nor associations with HIV treatment outcomes longitudinally.

METHODS

Data were drawn from a prospective, observational cohort study (n = 500) of ART-eligible adults recruited from two HIV voluntary counseling and testing centers in Cape Town, and Johannesburg, South Africa. Multiple logistic regression models assessed recreational ART use as a predictor of ART initiation over six months and viral load suppression over nine months, above and beyond other substance use (binge drinking and illicit drug use).

RESULTS

Approximately 5% (n = 24) reported recreational ART use, which was less frequent in Cape Town compared to Johannesburg (AOR = 0.025; 95%CI: 0.003-0.19; p < 0.001). Recreational ART use was not significantly associated with ART initiation or viral suppression. Other substance use, but not recreational ART use, was significantly associated with lower odds of ART initiation (AOR = 0.54; 95%CI: 0.33-0.87; p = .01) and viral suppression (AOR = 0.47; 95%CI: 0.25-0.89; p = .02).

CONCLUSIONS

Recreational ART use was infrequent and not uniquely associated with ART initiation or viral suppression. Findings suggest that comorbid use of other substances is ultimately what may make recreational ART use problematic for ongoing engagement in care and viral suppression.

Address: Department of Psychology, University of Maryland, College Park, 4095 Campus Drive, College Park, MD, USA. Electronic address: [email protected].; Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA. Electronic address: [email protected].; Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, USA. Electronic address: [email protected].; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA. Electronic address: [email protected].; Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. Electronic address: [email protected].; Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa. Electronic address: [email protected].; Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. Electronic address: [email protected].; Department of Medicine and the Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, ZA, South Africa. Electronic address: [email protected].; Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Office of the President, South African Medical Research Council, Western Cape, ZA, South Africa. Electronic address: [email protected].; Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA. Electronic address: [email protected].; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Global Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].

DOI: 10.1016/j.drugalcdep.2019.02.009

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MeSH Terms: Adolescent, Adult, Anti-Retroviral Agents, Counseling, Female, HIV, HIV Infections, Humans, Logistic Models, Longitudinal Studies, Male, Prescription Drug Misuse, Prospective Studies, South Africa, Substance-Related Disorders, Viral Load