Alcohol and Drug Abuse Research Unit

Report to Parliament 2009: Alcohol and Drug Abuse Research Unit
Selected Research Highlights 2008-9

In July 2008, the WHO co-sponsored a technical meeting hosted by ADARU in Cape Town to review evidence relating to the linkages between alcohol consumption and selected infectious diseases and examine potential causal impacts of alcohol use on both the incidence and course of HIV/AIDS and TB.  A review of the evidence produced a consensus that there was conclusive evidence of a causal linkage between heavy drinking patterns and/or alcohol use disorders and the incidence of active TB, and that these exposure categories were also causally linked to worsening of the disease course for both TB and HIV. Alcohol consumption was also shown to have a negative effect on adherence to HIV medication regimens. Participants, however, concluded that while alcohol use was consistently associated with the prevalence and incidence of HIV, further research was needed to substantiate causality. A summary of the main findings of the meeting appeared in Addiction in March 2009.

ADARU (Pretoria) is conducting a project to investigate the role played by alcohol in non-adherence to antiretroviral therapy (ART). The formative phase of this project evaluated the perspectives of ART recipients and health care providers on this issue. Using purposive sampling, 13 single-gender focus group discussions (FGDs) were run with male and female ART recipients who drank alcohol, and 17 in-depth interviews (IDIs) were conducted with health care providers across six ART sites in Gauteng. The viewpoint of most of the health care providers was that alcohol reduces ART’s effectiveness and worsens some ART agents’ side effects; hence ART recipients were advised to abstain from alcohol. Furthermore, most health care providers believed that heavy alcohol use could lead to non-adherence to ART via the mechanism of “forgetting” to take the ART medication. Despite being told that “ART and alcohol do not mix”, a substantial number of ART recipients indicated that in their view, alcohol and ART “agree with each other” because of the absence of nausea/vomiting upon concurrent ART and alcohol use and having been able to achieve optimal ART outcomes such as low viral loads and high CD4 counts despite concurrent alcohol consumption. The team also examined how ART programmes address hazardous alcohol use among treatment recipients. It was concluded that an apparent lack of knowledge that alcohol use is not contraindicated for any of the ART agents (except for patients with HIV/Hepatitis B co-infection) may have placed health care providers at risk of imparting inaccurate advice. Improved training for health care providers regarding ART, adherence and alcohol use is urgently needed.

In 2007, in collaboration with five NGOs, an initiative was begun to roll out a number of harm reduction strategies aimed at vulnerable drug using populations, specifically women who engage in transactional sex (CSWs), men who have sex with men (MSM), and injection and non-injection drug users (IDUs/NIDUs) in Cape Town, Durban and Pretoria. Activities include outreach; condom distribution and other preventive interventions; provision of VCT; and referrals to drug, HIV and other services. Over the first 8 months of the project 3221 drug users were reached through outreach that promotes HIV and AIDS prevention and addresses drug risk behaviors and 474 received VCT and their results. The intervention to date has demonstrated the willingness among NGOs to expand the skills base of their staff and broaden their outreach and service delivery activities, and a strong uptake of VCT and other services by vulnerable drug using populations.