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The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi.

Publication ,  Journal Article
Lancaster, KE; Lungu, T; Mmodzi, P; Hosseinipour, MC; Chadwick, K; Powers, KA; Pence, BW; Go, VF; Hoffman, IF; Miller, WC
Published in: AIDS Care
February 2017

Female sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi.

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Published In

AIDS Care

DOI

EISSN

1360-0451

Publication Date

February 2017

Volume

29

Issue

2

Start / End Page

197 / 203

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Sex Workers
  • Public Health
  • Prevalence
  • Medication Adherence
  • Marijuana Abuse
  • Male
  • Malawi
  • Humans
 

Citation

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Chicago
ICMJE
MLA
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Lancaster, K. E., Lungu, T., Mmodzi, P., Hosseinipour, M. C., Chadwick, K., Powers, K. A., … Miller, W. C. (2017). The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi. AIDS Care, 29(2), 197–203. https://doi.org/10.1080/09540121.2016.1211244
Lancaster, Kathryn E., Thandie Lungu, Pearson Mmodzi, Mina C. Hosseinipour, Katy Chadwick, Kimberly A. Powers, Brian W. Pence, Vivian F. Go, Irving F. Hoffman, and William C. Miller. “The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi.AIDS Care 29, no. 2 (February 2017): 197–203. https://doi.org/10.1080/09540121.2016.1211244.
Lancaster KE, Lungu T, Mmodzi P, Hosseinipour MC, Chadwick K, Powers KA, et al. The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi. AIDS Care. 2017 Feb;29(2):197–203.
Lancaster, Kathryn E., et al. “The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi.AIDS Care, vol. 29, no. 2, Feb. 2017, pp. 197–203. Pubmed, doi:10.1080/09540121.2016.1211244.
Lancaster KE, Lungu T, Mmodzi P, Hosseinipour MC, Chadwick K, Powers KA, Pence BW, Go VF, Hoffman IF, Miller WC. The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi. AIDS Care. 2017 Feb;29(2):197–203.

Published In

AIDS Care

DOI

EISSN

1360-0451

Publication Date

February 2017

Volume

29

Issue

2

Start / End Page

197 / 203

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Sex Workers
  • Public Health
  • Prevalence
  • Medication Adherence
  • Marijuana Abuse
  • Male
  • Malawi
  • Humans