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The life-saving effects of antiretroviral therapy (ART) in treating HIV infection are compromised by alcohol use. A growing body of research shows that both unintentional (e.g., memory lapses) and intentional (e.g., forgoing ART to avoid mixing with alcohol) contribute to ART non-adherence. Beliefs that it is harmful to mix alcohol with ART (alcohol-ART interactive toxicity beliefs) contribute to intentional non-adherence, but their role in overall adherence is not clear. This study conducted a clinic-based survey with 100 men and 193 women (mean age = 36) to examine the prevalence of alcohol-ART interactive toxicity beliefs and whether they contribute to treatment non-adherence in South Africa. One in three (36%, n = 106) participants reported no current alcohol use and 64% (n = 187) reported current alcohol use. The majority of participants, including current alcohol drinkers, endorsed beliefs that it is harmful to mix ART and alcohol, with 57% who currently drink reporting that they forgo taking ART when they are drinking. Participants reported being warned not to mix alcohol and ART from family, friends, and health care providers. In addition, 62% of participants who do not drink, as well as 36% of those who do drink, tell others not to mix alcohol and ART. Mediation modelling found that alcohol use directly predicts ART adherence, and that this relationship is partially mediated by alcohol-ART interactive toxicity beliefs. Health care providers can play a critical role in disputing interactive toxicity beliefs and encouraging patients to take ART even when they are drinking., Author(s): Seth C. Kalichman [sup.1] , Catherine Mathews [sup.2] , Ellen Banas [sup.1] [sup.2] , Moira O. Kalichman [sup.1] Author Affiliations: (1) grid.63054.34, 0000 0001 0860 4915, Institute for Collaboration [...]

Byline: John Chalker, MBChB, MSc, PhD (Center for Pharmaceutical Management, Management Sciences for Health, Arlington, Virginia, jchalker@msh.org); Tenaw Andualem, BPharm, BA, MSc (Department of Pharmacology, Faculty of Medicine, Addis Ababa [...]

Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub‐Saharan Africa suffering by far the greatest humanitarian, demographic and socio‐economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA‐CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site). Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother‐to‐child HIV transmission programs. At the time of the survey, there were 21,599 HIV‐positive adults (median age=37 years) enrolled in the clinical cohort. Though two‐thirds were women, few adults (6.5%) entered HIV care through prevention of mother‐to‐child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two‐thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%). Conclusions: Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV‐positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource‐limited settings such as those in this region. Country differences in the cohort's site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa., Introduction Despite the recent advances in the management of HIV infection and the increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global [...]