Objective: To assess the magnitude of alcohol use and factors among HIV/AIDS positive adults visiting ART clinic at Mizan Tep university Teaching Hospital (MTUTH), Southern Ethiopia from October 2017 to December 2017.
Result: A total of 332 participants were enrolled in the study with the prevalence of alcohol use disorder (AUD) of 18.4%. Factors associated with alcohol use disorder were sex AOR=3.48 (95%CI: 1.27, 9.59), cigarette smoking AOR=5.12(95%CI:4.02,8.61), “Khat” chewing AOR=3.23(95%CI: 2.06,6.89),and CD4 count of 0-200 AOR = 19.49 (95% CI:1.74 ,218.4).
Key words:-Magnitude, Alcohol use disorder, factors.
Human Immune virus (HIV) is a virus affecting more than 60 million peoples since epidemic had began . In 2013 an estimated 35.0 [33.2-37.2,] million people were living with HIV worldwide. Sub-Saharan Africa is home to only 12% of the global population, yet accounts for 71% of the global burden of HIV infection .
Ethiopia is one of the Sub-Saharan African countries where there is high rate of HIV/AIDS infection next to South Africa and Nigeria. According to the (Ethiopia Demographic health survey (EDHS) in 2011 indicated that Gambela region had the highest incidence of HIV /AIDS6%.  . Alcohol is a psychoactive substance with dependence producing properties that has been widely used in many cultures for centuries. Harmful use of alcohol causes a large degree of health problem as well as social and economic burden in societies .
Alcohol use disorders among people living with HIV/ AIDS (PLWHA) seems to be 2–4 times higher than those disorders in the general population .
The studies also reveal that in Sub Saharan African countries, particularly in Nigeria, infectious diseases make up 50% of the overall alcohol-attributable disease burden [6, 7]
Alcohol use among HIV patients plays an important role in their health outcomes and complicates the infection process by contributing to co-morbid diseases and drug interactions. It also increases opportunistic infection to be strengthened among ART users. Alcohol consumption has been also shown to decrease adherence and effectiveness to highly active ant retro viral therapy (HAART). It had also effect on the liver which affects drug metabolism, enhance viral load. Besides, it has also had effect on certain clinical and laboratory parameters, resulting in poor clinical outcome [8, 9] .So, certain factors affecting alcohol abuse and the consequences that such behaviours can have on the evolution of the disease are amendable to intervene. The identification of these factors may be useful in the implementation of actions aimed at controlling alcohol use and providing relevant information for detecting individuals at a higher risk of adverse clinical outcomes.
To assess the magnitude and associated factors of alcohol use disorder among PLWHA attending ART clinic at MTUTH, Southwest Ethiopia, 2018.
To determine the magnitude of alcohol use disorder among PLWHA attending ART clinic, MTUTH, Southwest Ethiopia, 2018.
To identify associated factors with alcohol use among PLWHA attending ART clinic, MTUTH, southwest Ethiopia, 2017.
Study Area and Period
The study was conducted at Mizan Tep university hospital from October 10 to December 9, 2017, which is located in southern nation nationality people region (SNNPR) of Ethiopia .It is 832 km from the capital city of the region called Hawassa. It is also 588 km`s from Addis Ababa, which is the capital city of the country. It provides different services for outpatient and inpatient population from SNNPR and neighbouring region called Gambela and Oromia in Ethiopia.
Institutional based cross-sectional study design was used.
All HIV positive patients who have follow up at ART Clinic in MTUTH, Southwest Ethiopia during data collection period.
Those sampled HIV positive patients who attend ART clinic during the study period in the hospital
Sampled HIV positive patients with age greater than or equal to 15 years were included in the study.
Exclusion criteria:-sampled patients who were unwilling to give informed consent and severely ill
Sample size determination
The required sample size was calculated by using single population proportion formula. The Proportion of alcohol use disorder among PLWHA was used from cross sectional study done at Jimma in 2012 which is 32.6%  with 5% marginal error and 95% confidence interval (CI) of certainty (alpha=0.05).
n = (Zα/2)2 P (1-P)
Where: n= sample size, Z α/2= Critical value=1.96
P= Prevalence of alcohol use among PLWHA=0.326 (32.6%)
d= precision (marginal error) =0.05
Therefore, n = (Zα/2)2 P (1-P) / d2, n = (1.96)2 *0.326 (1 -0.326)/ (0.05)2 =338
Since total number of HIV positive patients visiting ART clinic at HUCSH are <10,000, we used correction formula to know the final sample size as follows.
nf = ni where: ni – Initial sample size
1 + ni/N nf – Final sample size
nf = 338 N – Total number of PLWHA visiting ART clinic
nf = 301.78302
Ten percent of the calculated value of non-respondents will be 30.2.
nf = 302+30.2 , nf = 332.2332
Study participants were selected by systematic sampling method by drawing those ART patients having follow up in the ART registration book by establishing the sampling frame. The sample size for the study comprised of 332 patients who were selected by systematic random sampling, calculating sampling interval 𝐾= (𝑁/Tsz). 𝑁 denotes total numbers of patients having ART follow up during the study period in MTUTH which was 1024 and Tsz is the total sample size. So, every 3nd patient was selected from sampling frame. The sampled ART outpatients were present and exit interviews were carried out.
Alcohol use disorder
:-Age, sex, marital status, occupational, educational status, religion, ethnicity, living condition and income.
Clinical variables:-stage of HIV, year of serostatus, CD4 count, Viral load, HIV/AIDS stage, On ART or not, social support and HIV related stigma.
Substance use:-Tobacco , Khat, Cocaine, Alcohol.
Data Collection Instruments
Data was collected by semi structured self-administered questionnaire prepared in English and translated into Amharic and re translated to English to ensure its consistency. The questionnaires are adopted and modified from WHO-substance use survey questionnaire. It consists of socio-demographic variables, substance use, health status and stigma related questions. The structured questioner, Oslo-3 social support scale, perceived HIV stigma scale and Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol use disorder. Supervision was done while data collectors collect data and the information was checked for completeness and internal consistency.
Data Processing and Analysis
Data was checked and coded for its completeness and entered into Epidata 3.1 version then Statistical Package for Social Sciences (SPSS) version 20 was used for analysis. Both descriptive and inferential statistics procedures were undertaken. Tables and figures were used to present the data. Binary logistic regression model was used to identify factors associated with alcohol use disorder. Crude and adjusted odds ratios with 95% confidence interval were used to determine the strength of association between dependent and independent variables. Those Variables with P value <0.05 were considered as significant.
Social Drinker: The total AUDIT scores of the drinkers among 1 to 7.
Hazardous Drinking: the total AUDIT scores of the drinkers among 8 to 15.
Harmful Drinking: the total AUDIT scores of the drinkers among 16 to 19.
Alcohol Dependence: the total AUDIT scores of the drinkers among 20 to 40.
Alcohol use disorder: a patient who scored AUDIT scores > 8.
Poor support: Those who score <8 in Oslo-3 Social Support Scale (OSS-3)
Perceived stigma: Those who score > 11 in HIV Stigma Scale
Dissemination and Utilization
Finally the result from this study was disseminated to MTUTH
Ethical clearance was obtained from Mizan Aman health Science College and permission was obtained from MTUTH. All participants of the study were asked and signed an informed consent after elaborating clearly the objectives of the study. Their right to refuse were also kept honestly.
A total of 332 participants were enrolled with a response rate of 100%. Most of the participants, 184 (55.4%) were females. The mean age of the respondents was 37.89(SD 10.27). Ninety five (28.6%) were kaffa and 66(19.9%) Amhara by ethnicity. The educational level of 126 (38%) respondents was found to be in primary school (See Table 1 below).
Magnitude of Alcohol use disorder
The prevalence of alcohol use disorder was found to be 18.4%. The prevalence of social drinkers hazardous drinkers, harmful alcohol users , and alcohol dependents were computed to be 32.2%, 11.4%, 1.8%, 0.9%, respectively. Most of the respondents, 178 (53.6%) were non-alcohol users.
Associated factors for AUD among PLWHA
In the binary logistic regression; sex, age education level, occupation, cigarette smoking, “khat” chewing, CD4 count were significantly associated with alcohol use disorder. But in multivariate analysis. Sex, Cigarette Smoking, “khat” chewing, and CD4 count were independently associated with alcohol use disorder (See Table 2 below).
This study reveals that the prevalence of alcohol use disorder (AUD) was 18.4% which is higher than similar studies done in 2015 at “Bishoftu” in Ethiopia which was 14.2% . It was in line with that of Jimma study which is 32.6% of PLWHA have been found to be alcohol use disorder . Therefore, this study gives additional evidence for designing interventions for alcohol use disorder among HIV infected patients because of uniformly distributed throughout south west part of the country.
An overview of globally done studies on the topic reveals that the prevalence ranges from 1.4% in Uganda to 49.5% in Brazil . The possible explanation for this might be cultural, socioeconomic and contextual differences. The sample size variation and instruments used to assess AUD differences were also the possible reasons that make the dissimilarity at both ends .
Our study showed that males had 3 times higher risk for AUD than females. This study result is higher than the study done in jimma and Nigeria [10, 14]. The possible explanation for this might be the cultural and economic dominance of males in Africa.
This study also showed that those who smoke cigarettes had 5 times greater risk than non smokers to had alcohol use disorder. This finding is higher than the different study done in [15, 10]. Therefore, this study gives additional evidence for planning appropriate intervention in smoking among HIV infected patients. So, different studies also indicated that individuals who drink had a probability to be engaged in smoking.
In this study; those participants who chew “khat” were 3 times more likely to had AUD as compared to those non “khat” chewers. This finding is higher than the study done in Jimma, Ethiopia . So, this might be due to one of more “khat” growing region and a chewing practice is prevalent region in Ethiopia. So, designing strategies will be vital to minimize chat chewing prevalence since it is associated with alcohol use disorder.
This study also indicated that those PLWHA having CD4 count of <200 had 19 times more likely to had alcohol use disorder when compared to those PLWHA having > 500 CD4 count. This study result is also supported by studies done in Brazil in 2013. This is due to direct immune suppressive effect of alcohol. . This is might be due to knowing their low CD4 count makes them to use alcohol excessively.
The prevalence of alcohol use disorder was high. Alcohol use disorders were independently associated with male patients, cigarette smokers, “khat” chewers, and those with low CD4 count.
Providing health education about alcohol use disorder and its devastating effect of alcohol in the health institution as well in the community will be essential to decrease those who will have alcohol use disorder. Besides, proper screening of alcohol use disorder among patients with HIV/AIDS is crucial. Moreover, strengthening the referral linkage with psychiatric units for psycho behavioural therapy will decreases the burden of the problem and brought change on ART patient.
There may be recall bias and social desirability bias
AIDS: Acquired Immune Deficiency Syndrome
ART: Anti-Retroviral Therapy
AUDIT: Alcohol Use Disorder Identification Test
HIV: Human Immunodeficiency Virus
HAART: Highly Active Anti-Retroviral Therapy
MTUTH: Mizan Tep university Teaching Hospital
OSS-3: Oslo-3 Social support Scale
PLWHA: People Living With HIV/AIDS
UNICEF: United Nations International Children’s Emergency Fund
WHO: World Health Organization.
Ethics approval and consent to participate
The study was conducted after approval of ethical review committee of Mizan Aman Health Science College. Permission to conduct the study was obtained from authorities at Mizan Tep University Teaching Hospital. Written informed consent was obtained from each study participant by assuring privacy and confidentiality throughout the data collection period in the Hospital. An individual who was unwilling to participate from the beginning or at any part of the interview was allowed to withdraw. There was no risk or hazardous procedures putting the participants at harm.
Consent to publish
I am a corresponding author and first author of this finding.
Availability of data and materials
The data supporting the finding were avail in public repositories.
There is no competing interest.
No funding is required.
The author contributes for this study in analysing the data gathered and preparing this manuscript.
First of all I would like to acknowledge Mizan Aman health Science College for provision of an ethical clearance. I would also like to acknowledge Mizan Tep University Teaching Hospital for providing of permission for study to be conducted.
My gratitude also goes to data collectors and friends for their all rounded support throughout the completeness of the data.
1. UNAIDS/WHO, AIDS epidemic update, December 2001, UNAIDS/WHO 2001,Geneva, Switzerland.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). The Gap Report ISBN: 978-92-9253-062-4. 2014 [Accessed on 12 July 2015];
3. Ethiopian Demographic health survey (EDHS) 2011
4. WHO: Global status report on alcohol and health-2014
5. Mariana, K.B.; Carlin, R.; Shenghan, L.; Sabrina, S.; et al. 2009: Alcohol use accelerates HIV disease progression
6. Hahn JA, Woolf-King SE, Muyindike W: Adding fuel to the fire: alcohol’s effect on the HIV epidemic in Sub-Saharan Africa. Current HIV/AIDS Reports 2011, 8(3):172–180. https://doi.org/10.1007/s11904- 011-0088-2 PMID: 21713433
7. Farley J, Miller E, Zamani A, Tepper V, Morris C, Oyegunle M, Lin M, Charurat M, Blattner W: Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. Journal of the International Association of Phy- sicians in AIDS Care (JIAPAC) 2010, 9(4):218–226.
8.Pandrea, I.; Happel, K.T.; Amedee, A.M.; Bagby, G.J.; Nelson, S. 2010: Alcohol’s role in HIV transmission and disease progression.
9. Braithwaite Rs, Bryant KJ: influence of alcohol consumption on adherence to and toxicity of antiretroviral theraphy and survival. Alcohol Res Health 2010,33 (33):280-286.
10. Soboka M, Tesfay M, Tolu G, Hanlon C: Alochol use disorder and associated factors among people liv- ing with HIV who are attending services in Southwest Ethiopia. BMC Research Notes 7:828 2014. https://doi.org/10.1186/1756-0500-7-828 PMID: 25417542
11. Bultum JA, Yigzaw N, Demeke W, Alemayehu M (2018) Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia. PLoS ONE 13(3): e0189312.
12. Silva CM*, Mendoza-Sassi RA, Mota LD, Nader MM and Martinez AMBBMC Infectious Diseases (2017) 17:263 DOI 10.1186/s12879-017-2374-0
13. Silva CM*, Mendoza-Sassi RA, Mota LD, Nader MM and Martinez AMBBMC Infectious Diseases (2017) 17:263 DOI 10.1186/s12879-017-2374-0
14. Goar SG, Audu MD, Abbir MT, Dochalson E: prevalence and sociodemographic correlates of alcohol use disorder among HIV patients . AfrJ Drug Alcohol stud 2011,10 (1); 42-47
15. Znenbe Y, Negash A, Feyissa G, Krahl W: Alcohol use disorders and its associated factors among pychatric outpatients in Jimma University specialized hospital Southwest Ethiopia. J Alcohol Drug Depend 3:3 2015.