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 Bangsberg, Ingrid T. Katz

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)192-198
Number of pages7
JournalDrug and Alcohol Dependence
Volume198
DOIs
StatePublished - May 1 2019

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Recreation Therapy
Street Drugs
South Africa
Acquired Immunodeficiency Syndrome
HIV
Logistics
Testing
Therapeutics
Viral Load
Logistic Models
Binge Drinking
Observational Studies
Comorbidity
Counseling
Cohort Studies

Keywords

  • Alcohol use
  • Drug use
  • HIV/AIDS
  • Recreational antiretroviral therapy use
  • South Africa

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Recreational ART use among individuals living with HIV/AIDS in South Africa : Examining longitudinal ART initiation and viral suppression. / Magidson, Jessica F.; Iyer, Hari S.; Regenauer, Kristen S.; Grelotti, David J.; Dietrich, Janan J.; Courtney, Ingrid; Tshabalala, Gugu; Orrell, Catherine; Gray, Glenda E.; Bangsberg, David; Katz, Ingrid T.

In: Drug and Alcohol Dependence, Vol. 198, 01.05.2019, p. 192-198.

Research output: Contribution to journalArticle

Magidson, JF, Iyer, HS, Regenauer, KS, Grelotti, DJ, Dietrich, JJ, Courtney, I, Tshabalala, G, Orrell, C, Gray, GE, Bangsberg, D & Katz, IT 2019, 'Recreational ART use among individuals living with HIV/AIDS in South Africa: Examining longitudinal ART initiation and viral suppression', Drug and Alcohol Dependence, vol. 198, pp. 192-198. https://doi.org/10.1016/j.drugalcdep.2019.02.009
Magidson, Jessica F. ; Iyer, Hari S. ; Regenauer, Kristen S. ; Grelotti, David J. ; Dietrich, Janan J. ; Courtney, Ingrid ; Tshabalala, Gugu ; Orrell, Catherine ; Gray, Glenda E. ; Bangsberg, David ; Katz, Ingrid T. / Recreational ART use among individuals living with HIV/AIDS in South Africa : Examining longitudinal ART initiation and viral suppression. In: Drug and Alcohol Dependence. 2019 ; Vol. 198. pp. 192-198.
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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.",
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T1 - Recreational ART use among individuals living with HIV/AIDS in South Africa

T2 - Examining longitudinal ART initiation and viral suppression

AU - Magidson, Jessica F.

AU - Iyer, Hari S.

AU - Regenauer, Kristen S.

AU - Grelotti, David J.

AU - Dietrich, Janan J.

AU - Courtney, Ingrid

AU - Tshabalala, Gugu

AU - Orrell, Catherine

AU - Gray, Glenda E.

AU - Bangsberg, David

AU - Katz, Ingrid T.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

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KW - Drug use

KW - HIV/AIDS

KW - Recreational antiretroviral therapy use

KW - South Africa

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