Patterns and predictors of antiretroviral therapy use among alcohol drinkers at HIV clinics in Tshwane, South Africa

Alcohol use is associated with compromised antiretroviral therapy (ART) adherence. We aimed to identify patterns and predictors of ART use among alcohol drinkers. Using purposive sampling, we recruited 304 male and female patients from two ART clinics in Tshwane, South Africa. Interviews were conducted using a structured questionnaire comprising measures of demographic factors, psychosocial factors (i.e., ART adherence, self-efficacy beliefs, alcohol and ART interactions beliefs, ART-alcohol outcome expectancy, attitude towards drinking alcohol and taking ART and HIV stigma) and alcohol use (AUDIT). Data were analysed using descriptive statistics and three multivariate linear regressions. Forty percent of the sample reported drinking alcohol. Half of the drinkers endorsed one of three unique patterns of ART use: (1) dosing ART earlier than required (2) taking ART while drinking alcohol and (3) skipping ART doses. The other half endorsed combinations of ART use on drinking days, for example, earlier ART dosing and taking ART while drinking alcohol was the most common combination. High adherence perseverance (a self-efficacy subscale) and a non-favourable attitude towards drinking alcohol and taking ART predicted the unique pattern of taking ART early when planning to drink alcohol. The unique pattern of taking ART despite drinking alcohol was predicted by higher levels of education (marginal significance) and experiencing low HIV stigma. A high score on the AUDIT and experience of high stigma predicted the unique pattern of skipping ART doses when drinking alcohol. Patterns of ART taking in alcohol drinkers in this sample are varied, and not always mutually exclusive. This apparent complexity of medication taking patterns among alcohol drinkers warrants further exploration. Furthermore, the finding that different psychosocial factors predict different ART-taking patterns suggests a need for programmes to improve alcohol-related non-adherence to ART to be multifaceted.