Assessing the role of alcohol and intimate partner violence on HIV care and viral suppression in Uganda

Background: HIV, alcohol use and intimate partner violence (IPV) are critical interrelated public health issues in the Rakai region of Uganda. There is a growing evidence base that suggests that alcohol use adversely impacts HIV treatment outcomes. Findings regarding the effects of alcohol use on viral suppression have been inconclusive. Similarly, experiencing IPV is also associated with poor treatment outcomes. Although IPV and alcohol use are frequently co-occurring, their combined effects on treatment outcomes has not been explored. Objective: To assess how alcohol use and IPV independently (aims 1 and 2, respectively) and as co-occurring issues (aim 3) relate to HIV treatment outcomes among persons living with HIV (PLWH) participating in the Rakai Community Cohort Study (RCCS).Methods: Data from two consecutive rounds (2017-2020) of the RCCS, a prospective population-based HIV surveillance study, were analyzed. Multivariable models were built to explore associations between past year alcohol use, IPV and current ART use and viral suppression (<=1000 copies/mL) To explore the relationship between alcohol use and the HIV outcomes (aim 1), Generalized Estimating Equations were built to adjust for correlations from within person observations at two visits with analyses run overall and stratified by sex. Prospective associations between IPV and the HIV outcomes among women were explored using logistic regression models weighted with inverse probability weights (aim 2). Mediation and moderation analyses were performed to explore temporal pathways between IPV, alcohol use and the HIV outcomes (aim 3). Results: For aim 1, the sample consisted of 3,823 PLWH. Alcohol use was associated with significantly worse treatment outcomes among women but not men. Among alcohol users, experiencing alcohol-related consequences was associated with worse outcomes among men but not women. In aim 2, among women reporting past year sexual activity at baseline (n=1,923), experiencing IPV was not associated with worse treatment outcomes. None of the mediating or moderated pathways explored in aim 3 were significant.Conclusions: Alcohol use should be a target of intervention to improve HIV treatment outcomes. Given the frequent co-occurrence of HIV, alcohol use and IPV in this setting more research is needed to understand how these variables relate