Allen Kekibiina - Academia.edu (original) (raw)

Papers by Allen Kekibiina

AIDS and Behavior, 2022

Screening and assessing alcohol use accurately to maximize positive treatment outcomes remain pro... more Screening and assessing alcohol use accurately to maximize positive treatment outcomes remain problematic in regions with high rates of alcohol use and HIV and TB infections. In this study, we examined the concordance between self-reported measures of alcohol use and point-of-care (POC) urine ethyl glucuronide (uEtG) test results among persons with HIV (PWH) in Uganda who reported drinking in the prior 3 months. For analyses, we used the screening data of a trial designed to examine the use of incentives to reduce alcohol consumption and increase medication adherence to examine the concordance between POC uEtG (300 ng/mL cutoff) and six measures of self-reported alcohol use. Of the 2136 participants who completed the alcohol screening, 1080 (50.6%) tested positive in the POC uEtG test, and 1756 (82.2%) self-reported using alcohol during the prior 72 h. Seventy-two percent of those who reported drinking during the prior 24 h had a uEtG positive test, with lower proportions testing uEtG positive when drinking occurred 24–48 h (64.7%) or 48–72 h (28.6%) prior to sample collection. In multivariate models, recency of drinking, number of drinks at last alcohol use, and Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) score were associated with uEtG positivity. The highest area under the curve (AUC) for a uEtG positive test was for recency of drinking. Overall, we concluded that several measures of drinking were associated with POC uEtG positivity, with recency of drinking, particularly drinking within the past 24 h, being the strongest predictor of uEtG positivity.

AIDS Care, 2020

Although there is evidence of individual associations between depressive symptoms and hazardous a... more Although there is evidence of individual associations between depressive symptoms and hazardous alcohol use with suboptimal antiretroviral therapy (ART) adherence among people living with HIV (PLWH), few studies have established how the two risk factors may interact to predict viral suppression. We conducted secondary data analyses with two cohorts of Ugandan PLWH (N = 657) to investigate the hypothesized interaction between depressive symptoms (Center for Epidemiological Studies Depression Scale) and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption and/or Phosphatidylethanol biomarker) prior to ART initiation with viral suppression (<550 copies/ml). We were unable to detect an interaction between depressive symptoms and hazardous alcohol use prior to ART initiation with viral suppression in the first two years (M = 19.9 months) after ART initiation (p = 0.75). There was also no evidence of a main effect association for depressive symptoms (Adjusted Odds Ratio [AOR] = 0.88, 95% Confidence Interval [CI]: 0.50, 1.55) or hazardous alcohol use (AOR = 1.37, 95% CI: 0.80, 2.33). PLWH with depressive symptoms and/or hazardous alcohol use appear to exhibit similar levels of viral suppression as others in care; further work is needed to determine effects on HIV testing and treatment engagement.

Clinical Infectious Diseases, 2020

We assessed associations between hazardous alcohol use and latent tuberculosis infection (LTBI) a... more We assessed associations between hazardous alcohol use and latent tuberculosis infection (LTBI) among adults living with human immunodeficiency virus (HIV) in Uganda. We compared tuberculin skin test positivity across medium, high, and very-high alcohol use levels, classified by AUDIT-C scores. In multivariable analysis, very high use was associated with LTBI (adjusted odds ratio 1.61, 95% confidence interval: 1.03–2.50).

Alcoholism: Clinical and Experimental Research, 2019

Introduction: Self-report is widely used to assess alcohol use in research and clinical practice,... more Introduction: Self-report is widely used to assess alcohol use in research and clinical practice, but may be subject to social desirabilitybias. We aimed to determine if social desirability impacts self-reported alcohol use. Methods: Among 751 HIV-infected patients from a clinic in Southwestern Uganda,we measured social desirability using the Marlowe-Crowne Social Desirability Scale (SDS) Short Form C, selfreported alcohol use (prior 3 months) AUDIT-C, and phosphatidylethanol (PEth), a biomarker of prior 3 weeks' drinking. We conducted multiple regression analyses to assess the relationship between SDS score (low, medium, and high levels) and (1) any self-reported recent alcohol use, among those who were PEth-positive (≥8ng/ml), and (2) continuous AUDIT-C score, among those reporting any recent alcohol use. We controlled for PEth level, age, gender, education, economic assets, marital status, religion, spirituality/religiosity, social support, and study cohort. Results: Of 751 participants, 59% were women; the median age was 31 years (interquartile range [IQR]: 26-39). Median SDS score was 9 (IQR: 4-10). Two-thirds (62%) self-reported any recent alcohol use; median AUDIT-C was 1(IQR: 0-4). Among those who were PEth-positive (57%), 13% reported no recent alcohol use. Those with the highest SDS tertile had decreased odds of reporting any recent alcohol use compared to the lowest tertile, but the association did not reach statistical significance in multivariable analyses (adjusted odds ratio 0.55 [95% Confidence Interval (CI): 0.25,1.23]). Among participants self-reporting recent alcohol use, SDS level was negatively associated with AUDIT-C scores (adjusted β: −0.70 [95% CI: −1.19, −0.21] for medium versus low SDS and −1.42 [95% CI: −2.05, −0.78] for high versus low SDS).

Journal of Studies on Alcohol and Drugs, 2017

Unhealthy alcohol use is a crucial driver of HIV in sub-Saharan Africa, and interventions are nee... more Unhealthy alcohol use is a crucial driver of HIV in sub-Saharan Africa, and interventions are needed. The goal of this study was to assess whether assessment itself (assessment reactivity) causes declines in alcohol use in a research study in persons with HIV in Uganda. Method: Study participants were adult patients of the Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda, who were new to HIV care and reported any alcohol consumption in the prior year. Participants were randomized to (a) a study cohort, with structured interviews, breath alcohol analysis tests, and blood draws conducted quarterly, or (b) a minimally assessed arm that engaged in these procedures only once, at 6 months after baseline. The main outcome was unhealthy drinking at 6 months, defined as Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] positive (3 for women, 4 for men) or phosphatidylethanol (PEth; an alcohol biomarker) level 50 ng/ml. We also examined this outcome stratified by gender. Results: We examined 175 and 139 persons in the quarterly assessed versus minimally assessed arms, respectively. Overall, 54.8% were male, the median age was 30 (interquartile range: 25-36), and 58.0% initiated anti-retroviral therapy at 6 months. Nearly equal proportions (53.7% and 51.1% in the study quarterly assessed vs. minimally assessed arm, respectively) engaged in unhealthy drinking in the 3 months before the 6-month study visit (p = .64), and we found no evidence of interaction by gender (p = .36). Conclusions: We found no evidence of assessment reactivity in a study that included quarterly study visits. Assessment is not sufficient to act as an intervention itself in this population with high levels of unhealthy drinking. Interventions are needed to decrease alcohol consumption in this population.

AIDS and Behavior, 2016

Interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapy (ART) may influe... more Interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapy (ART) may influence ART adherence. HIV-infected patients in Uganda completed quarterly visits for 1 year, or one visit at 6 months, depending on study randomization. Past month ART nonadherence was less than daily or \100 % on a visual analog scale. Participants were asked if people who take alcohol should stop taking their medications (belief) and whether they occasionally stopped taking their medications in anticipation of drinking (behavior). Visits with self-reported alcohol use and ART use for C30 days were included. We used logistic regression to examine correlates of the interactive toxicity belief and behavior, and to determine associations with ART non-adherence. 134 participants contributed 258 study visits. The toxicity belief was endorsed at 24 %, the behavior at 15 %, and any nonadherence at 35 % of visits. In multivariable analysis, the odds of non-adherence were higher for those endorsing the toxicity behavior [adjusted odds ratio (AOR) 2.06; 95 % confidence interval (CI) 0.97-4.36] but not the toxicity belief (AOR 0.63; 95 % CI 0.32-1.26). Clear messaging about maintaining adherence, even if drinking, could benefit patients.

Alcoholism: Clinical and Experimental Research, 2015

Background: In sub-Saharan Africa (SSA), HIV-infected patients may under-report alcohol consumpti... more Background: In sub-Saharan Africa (SSA), HIV-infected patients may under-report alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel non-volume measures, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Methods: We analyzed cohort-entry data from the Biomarker Research of Ethanol in Those with HIV cohort study (2011-2013). Participants were HIV-infected past year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman's rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CI) for pairwise differences between coefficients. Results: A total of 209 subjects (57% male) were included. Median age was 30; inter-quartile range (IQR) 25-38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2137) were higher than QF grams (375, IQR 33 to 1776), p<0.001. However, both measures were moderately correlated with PEth; rho = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference-0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (rho = 0.35 to 0.57). Conclusion: HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other non-volume measures may provide simpler alternatives.

BACKGROUND Alcohol brief interventions are effective for reducing alcohol use; however, they depe... more BACKGROUND Alcohol brief interventions are effective for reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often under-reported. Self-administered digital health screeners may improve reporting. OBJECTIVE Our first aim was to develop a brief touch-screen tablet based health screener to be administered in an HIV clinic waiting room, to increase reporting of unhealthy alcohol use for persons with HIV in Uganda. Our second aim was to pilot test the health screener developed in Aim 1 to examine acceptability, ease of use, comfort with reporting, and to discuss how the results of such screening might be used. METHODS We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener assessed behaviors regarding general health, HIV care, mental health, as well as sensitive topics such as alcoh...

BMC Psychiatry

Background We aimed to describe the prevalence of PTSD symptoms and its associated factors in per... more Background We aimed to describe the prevalence of PTSD symptoms and its associated factors in persons living with HIV (PLWH) in Uganda who engage in heavy alcohol use. Methods We analyzed baseline data from the Drinkers Intervention to Prevent Tuberculosis study which enrolls PLWH with latent tuberculosis who engage in heavy alcohol consumption. Using the primary care Post Traumatic Stress Disorder (PTSD) screening scale from the DSM-5 (PC-PTSD-5), probable PTSD was defined as reporting ≥3 of 5 assessed symptoms. We conducted the Alcohol Use Disorders Identification Test-Consumption and assessed demographics, smoking, symptoms of depression, and spirituality/religiosity. Results Of 421 participants enrolled from 2018 through 2020, the majority (68.2%) were male, median age was 40 years (interquartile range [IQR]: 32–47), and median AUDIT-C score was 6 [IQR: 4–8]. Half (50.1%) of the participants reported ever experiencing a traumatic event, and 20.7% reported ≥3 symptoms of PTSD. Th...

Archives of sexual behavior, Jan 11, 2018

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies desig... more While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in th...