Background
Person-centered HIV care and prevention that provide low-barrier access and non-judgmental interactions may address poor outcomes among persons with alcohol use. Alcohol use is a risk factor for: a) non-retention in care and viremia among PWH, and b) non-retention in biomedical prevention and HIV acquisition among persons without HIV. We sought to determine if person-centered care/prevention can mitigate these risks.
Methods
Within the intervention arm of the ongoing SEARCH trial (NCT05768763), we evaluated associations between alcohol use and HIV care/prevention outcomes at baseline and after 1 year. In 8 rural communities (~6000 adults each) in Kenya and Uganda in 2023, we conducted population-level HIV screening and asked about past 3-month alcohol use. PWH with/at-risk of viremia (defined as pregnant/breastfeeding, 15-24 years, not on ART, or viremic (≥200 c/mL)/no VL in past year) were referred to “life events assessment” person-centered care (LEAP): LEAP was designed to assess for issues that may impact ART use and included brief alcohol counseling for PWH with unhealthy alcohol use. Persons without HIV and reporting risk were referred to dynamic choice HIV prevention (DCP), which offered flexibility and choice of PrEP/PEP, clinic/off-site visits, and clinic/self-HIV testing.
Results
Of 47,844 adults screened, 8380 (18%) reported recent alcohol use. Of 4716 (10%) PWH, 661 (14%) enrolled in LEAP: 149/661 (23%) reported alcohol use and 256/628 (41%) had VL≥200. At LEAP baseline, alcohol use was associated with increased risk of untreated HIV (RR:1.6 [95%CI:1.1-2.3]) and viremia (RR of VL<200: 0.6[0.5-0.9)). One year into LEAP, 431 (66%) participants were retained and 210/234 (90%) with VL results were suppressed: there were no significant associations between alcohol use and retention (RR:1.0[0.8-1.2]), or alcohol use and viremia (RR of VL<200: 0.8[0.5-1.2]). Of 43,128 adults without HIV at baseline, 11% reported HIV risk: alcohol use was associated with HIV risk (RR:1.5[1.3-1.6]). Of 2,260 DCP participants, 1076 (48%) were retained at 1-year: there was no significant association between alcohol use and reported risk (RR:1.0[0.8-1.2]) or retention in DCP (RR:1.0[0.9-1.1]) at 1-year.
Conclusions
One year into SEARCH person-centered care/prevention interventions, baseline associations between alcohol use and poor outcomes were no longer observed. These results suggest that the SEARCH interventions may mitigate risks of alcohol use among PWH and adults reporting risk of HIV.