Muyindike Winnie R, Lloyd-Travaglini Christine, Fatch Robin, Emenyonu Nneka I, Adong Julian, Ngabirano Christine, Cheng Debbie M, Winter Michael R, Samet Jeffrey H, Hahn Judith A
a Faculty of Medicine , Mbarara University of Science and Technology , Mbarara , Uganda.
b Department of Medicine , Mbarara Regional Referral Hospital , Mbarara , Uganda.
AIDS Care. 2017 Nov;29(11):1442-1447. doi: 10.1080/09540121.2017.1290209. Epub 2017 Feb 13.
Under-reporting of alcohol use by HIV-infected patients could adversely impact clinical care. This study examined factors associated with under-reporting of alcohol consumption by patients who denied alcohol use in clinical and research settings using an alcohol biomarker. We enrolled ART-naïve, HIV-infected adults at Mbarara Hospital HIV clinic in Uganda. We conducted baseline interviews on alcohol use, demographics, Spirituality and Religiosity Index (SRI), health and functional status; and tested for breath alcohol content and collected blood for phosphatidylethanol (PEth), a sensitive and specific biomarker of alcohol use. We determined PEth status among participants who denied alcohol consumption to clinic counselors (Group 1, n = 104), and those who denied alcohol use on their research interview (Group 2, n = 198). A positive PEth was defined as ≥8 ng/ml. Multiple logistic regression models were used to examine whether testing PEth-positive varied by demographics, literacy, spirituality, socially desirable reporting and physical health status. Results showed that, among the 104 participants in Group 1, 28.8% were PEth-positive. The odds of being PEth-positive were higher for those reporting prior unhealthy drinking (adjusted odds ratio (AOR): 4.7, 95% confidence interval (CI): 1.8, 12.5). No other factors were statistically significant. Among the 198 participants in Group 2, 13.1% were PEth-positive. The odds of being PEth-positive were higher for those reporting past unhealthy drinking (AOR: 4.6, 95% CI: 1.8, 12.2), the Catholics (AOR: 3.8, 95% CI: 1.3, 11.0) compared to Protestants and lower for the literate participants (AOR: 0.3, 95% CI: 0.1, 0.8). We concluded that under-reporting of alcohol use to HIV clinic staff was substantial, but it was lower in a research setting that conducted testing for breath alcohol and PEth. A report of past unhealthy drinking may highlight current alcohol use among deniers. Strategies to improve alcohol self-report are needed within HIV care settings in Uganda.
艾滋病毒感染患者对饮酒情况报告不足可能会对临床护理产生不利影响。本研究调查了在临床和研究环境中，使用酒精生物标志物否认饮酒的患者饮酒情况报告不足的相关因素。我们在乌干达姆巴拉拉医院艾滋病毒诊所招募了未接受抗逆转录病毒治疗的艾滋病毒感染成年人。我们对他们进行了关于饮酒情况、人口统计学、精神与宗教指数（SRI）、健康和功能状态的基线访谈；检测了呼气酒精含量，并采集血液以检测磷脂酰乙醇（PEth），这是一种用于检测饮酒情况的敏感且特异的生物标志物。我们确定了向临床咨询人员否认饮酒的参与者（第1组，n = 104）以及在研究访谈中否认饮酒的参与者（第2组，n = 198）的PEth状态。PEth阳性定义为≥8 ng/ml。使用多元逻辑回归模型来检验PEth检测呈阳性在人口统计学、识字率、精神状态、社会期望报告和身体健康状况方面是否存在差异。结果显示，在第1组的104名参与者中，28.8%的人PEth呈阳性。既往报告有不健康饮酒史的人PEth呈阳性的几率更高（调整后的优势比（AOR）：4.7，95%置信区间（CI）：1.8，12.5）。没有其他因素具有统计学意义。在第2组的198名参与者中，13.1%的人PEth呈阳性。既往报告有不健康饮酒史的人PEth呈阳性的几率更高（AOR：4.6，95%CI：1.8，12.2），与新教徒相比，天主教徒的几率更高（AOR：3.8，95%CI：1.3，11.0），识字参与者的几率更低（AOR：0.3，95%CI：0.1，0.8）。我们得出结论，向艾滋病毒诊所工作人员报告饮酒情况不足的现象很普遍，但在进行呼气酒精和PEth检测的研究环境中这种情况较少。既往报告有不健康饮酒史可能会凸显否认饮酒者当前的饮酒情况。乌干达的艾滋病毒护理环境需要采取改善酒精自我报告的策略。
