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Alcohol screening tests predict adherence to antiretroviral regimens for persons with HIV/AIDS
Broyles LM, Gordon AJ, Sereika SM, Ryan CM, Erlen JA. Alcohol screening tests predict adherence to antiretroviral regimens for persons with HIV/AIDS. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2009 Nov 7; Bethesda, MD.
Background: Because alcohol use appears to negatively impact adherence to antiretroviral therapy (ART), HIV/AIDS care providers need accurate and efficient assessment of alcohol risk behavior. The extent to which positive scores on valid, popular clinical alcohol screening tests might predict medication nonadherence is largely unknown. Objective: The primary aim of this study was to determine if positive screening results on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and its single binge-drinking question (AUDIT-3) predict ART nonadherence. Methods: A secondary data analysis was conducted from a randomized controlled trial which tracked medication adherence with electronic event monitoring and tested the efficacy of two cognitive-behavioral ART adherence interventions over time. Participants were 308 individuals with HIV/AIDS. A series of sequential multiple linear regression analyses were performed to determine if positive alcohol screening results added to adherence prediction after controlling for various biopsychosocial factors identified as potential confounding variables and covariates. Results: The sample was approximately two-thirds male, over half self-identified as non-white ethnicity, and had a median age 44 years. The mean AUDIT-C score was 2.15 (SD = 2.59); 26.9% (n = 83) and 34.1% (n = 105) of the total sample were classified as AUDIT-C positive and AUDIT-3 positive, respectively. A positive AUDIT-C screen significantly added to the prediction of nonadherence after controlling for confounding variables (p = .029), but the same relationship barely failed to reach statistical significance after controlling for both confounding variables and covariates (p = .054). A positive AUDIT-3 screen did not significantly add to the prediction of nonadherence when controlling for confounders or both confounders and covariates simultaneously. Conclusions: A positive screen on the AUDIT-C serves as an indirect indicator of ART nonadherence and underscores the intersection of substance use and chronic disease management.