Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

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Abstract

Background

Alcohol use is a common practice of almost all communities worldwide and it is more common among persons with HIV infection. Alcohol consumption among people with HIV/AIDS may result in poor treatment adherence, further immunity suppression and increase the risk of comorbid illness (diseases) which collectively diminish the anti-retroviral therapy responses. Although there are separate studies conducted regarding alcohol use among people with HIV/AIDS in Ethiopia, the finding results are highly variable and inconsistent. Therefore, conducting a systematic review and meta-analysis has a paramount importance to show the pooled prevalence of alcohol use and to identify its determinants among people with HIV/AIDS.

Methods

A systematic search of electronic databases of PubMed/Medline, Science Direct, Hinnari and Cochrane library was employed. Additionally, the grey literature was searched from Google and Google Scholar. Data were extracted using a standardized data extraction format prepared in Microsoft Excel . STATA-version 14 statistical software was used for analysis. Heterogeneity of primary studies was found as evaluated using the I ² test result. As a result, a random-effect meta-analysis model was used to estimate the pooled prevalence of alcohol use.

Results

A total of 22 primary studies which comprises 8,368 study participants were included in this systematic review and meta-analysis. The pooled prevalence of lifetime, current and hazardous alcohol use among HIV patients in Ethiopia were 36.42% [95% CI (19.96, 52.89)], 19.00% [95% CI (12.98, 25.01)] and 21.64% [95% CI (12.72, 30.55)], respectively. Khat chewing [OR = 3.53, (95% CI 1.31, 9.51)] and cigarette smoking [OR = 7.04, (95% CI 3.53, 14.04)] were found as statistically significant determinants of hazardous alcohol use among people with HIV infection.

Conclusions

The result of this review showed that alcohol drinking is highly practiced among people with HIV/AIDS in Ethiopia. The magnitude of alcohol use was highly variable based on the screening methods used to measure alcohol use. Comorbid substance use (khat and cigarette) increases the risk of alcohol consumption among HIV patients. This suggests a need for designing appropriate and culturally applicable intervention programs and policy responses.

Trial registration PROSPERO 2019, “CRD42019132524.”

Supplementary Information

The online version contains supplementary material available at 10.1186/s12954-021-00503-6.

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Most cited references 41

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Bias in meta-analysis detected by a simple, graphical test

Jos I. M. Egger, G D Smith, M. Schneider … (1997)

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Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Maheswar Satpathy, Mika Kivimaki, Shafiu Mohammed … (2019)

Summary Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. Funding Bill & Melinda Gates Foundation.

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Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.

J. A. Sterne, M. Egger (2001)

Asymmetry in funnel plots may indicate publication bias in meta-analysis, but the shape of the plot in the absence of bias depends on the choice of axes. We evaluated standard error, precision (inverse of standard error), variance, inverse of variance, sample size and log sample size (vertical axis) and log odds ratio, log risk ratio and risk difference (horizontal axis). Standard error is likely to be the best choice for the vertical axis: the expected shape in the absence of bias corresponds to a symmetrical funnel, straight lines to indicate 95% confidence intervals can be included and the plot emphasises smaller studies which are more prone to bias. Precision or inverse of variance is useful when comparing meta-analyses of small trials with subsequent large trials. The use of sample size or log sample size is problematic because the expected shape of the plot in the absence of bias is unpredictable. We found similar evidence for asymmetry and between trial variation in a sample of 78 published meta-analyses whether odds ratios or risk ratios were used on the horizontal axis. Different conclusions were reached for risk differences and this was related to increased between-trial variation. We conclude that funnel plots of meta-analyses should generally use standard error as the measure of study size and ratio measures of treatment effect.

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Author and article information

Contributors

Birhanie Mekuriaw:

ORCID: http://orcid.org/0000-0002-0600-0234

birhanie2013@gmail.com

Zelalem Belayneh: zelalembe45@gmail.com

Alemayehu Molla: alexmolla09@gmail.com

Tsegaye Mehare: tseyeshe96@gmail.com

Journal

Journal ID (nlm-ta): Harm Reduct J

Journal ID (iso-abbrev): Harm Reduct J

Title: Harm Reduction Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7517

Publication date (Electronic): 17 May 2021

Publication date PMC-release: 17 May 2021

Publication date Collection: 2021

Volume: 18

Electronic Location Identifier: 55

Affiliations

[1 ]GRID grid.472268.d, ISNI 0000 0004 1762 2666, Department of Psychiatry, College of Health and Medical Science, , Dilla University, ; Dilla, Ethiopia

[2 ]GRID grid.472268.d, ISNI 0000 0004 1762 2666, Department of Biomedical Science, College of Health and Medical Science, , Dilla University, ; Dilla, Ethiopia

Author information

Birhanie Mekuriaw http://orcid.org/0000-0002-0600-0234

Article

Publisher ID: 503

DOI: 10.1186/s12954-021-00503-6

PMC ID: 8130112

PubMed ID: 34001138

SO-VID: 68429c76-df5f-4d19-a354-340aa54b634e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 December 2019

Date accepted : 9 May 2021

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ScienceOpen disciplines: Health & Social care

Keywords: prevalence,alcohol use,harmful drinking,determinants,hiv/aids,ethiopia

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ScienceOpen disciplines: Health & Social care

Keywords: prevalence, alcohol use, harmful drinking, determinants, hiv/aids, ethiopia

Alcohol use and its determinants among adults living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

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Annual Reviews HIV/AIDS: Public Health and Society

Most cited references 41

Bias in meta-analysis detected by a simple, graphical test

Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.

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