RESUMO
BACKGROUND: We determined the prevalence of and risk factors for alcohol misuse and illicit drug use among young Ugandans in fishing communities, a recognised "key population" for human immunodeficiency virus (HIV) infection. METHODS: We conducted a cross-sectional survey among young people (15-24 years) in fishing communities in Koome, Uganda, in December 2017-July 2018. Using Audio-Assisted Self-Interviewing, we collected data on socio-demographic characteristics and alcohol use, including the Alcohol Use Disorders Identification Test (AUDIT) and timeline follow-back calendar (TLFB). Blood samples were analysed for HIV, herpes simplex virus 2 (HSV2), and Phosphatidyl ethanol (PEth 16:0/18:1). Urine samples were analysed for illicit drugs. RESULTS: Among 1281 participants (52.7% male, mean age 20 years), 659 (51.4%) reported ever drinking alcohol, 248 (19.4%) had 12-month-AUDIT ≥ 8, and 261 (20.5%) had whole-blood PEth 16:0/18:1 concentration ≥ 20 ng/mL, indicating significant consumption. In multivariable analyses, PEth 16:0/18:1 ≥ 20ng/mL, AUDIT ≥ 8 and binge drinking (≥6 standard drinks per drinking occasion in the previous month from TLFB) were all strongly associated with older age, low education, smoking, and HSV2. Illicit drug use prevalence was 5.2% and was associated with older age, low education, being single, and smoking. CONCLUSION: Levels of alcohol misuse were high among young people in fishing communities and associated with HSV2, a proxy for risky sexual behaviour. Alcohol and illicit drug harm reduction services and HIV prevention programs in Uganda should prioritise young fisherfolk.
Assuntos
Consumo de Bebidas Alcoólicas , Drogas Ilícitas , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Estudos Transversais , Feminino , Pesqueiros , Humanos , Masculino , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Uganda/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Validated tools for assessing alcohol use among young people in low-income countries are needed to estimate prevalence and evaluate alcohol-reduction interventions. We validated Alcohol Use Disorders Identification Test (AUDIT) against Timeline Follow Back (TLFB), Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and phosphatidylethanol (PEth); and the 30-day-AUDIT against the 12-months-AUDIT among young Ugandans. METHODS: In 2018, we collected retrospective data on 30-day and 12-month AUDIT, TLFB and DSM-5 in a cross-sectional study of 15-24â¯year old residents of Ugandan fishing communities. AUDIT was administered by Audio Computer Assisted Self-Interviewing (ACASI) and DSM-5 and TLFB by psychiatric nurses. We determined PEth16:0/18:1 levels from dried blood spots using liquid chromatography tandem-mass spectrometry (heavy usage, ≥210â¯ng/mL) and calculated sensitivity and specificity of AUDIT against the other measures. RESULTS: Among 1281 participants (52.7% male, mean age 20â¯years), half (nâ¯=â¯659; 51.4%) reported ever drinking alcohol, 19.4% had 12-month-AUDITâ¯≥â¯8 (21.5% men; 17.0% women), and 24.2% had 30-day-AUDITâ¯≥â¯8 (29.0% men; 18.9% women). Twenty percent of participants had detectable PEth with 55 (4.3%) classified as heavy drinkers; 50.7% reportedâ¯≥â¯2 symptoms on DSM-5 and 6.3% reported binge drinking in the previous month based on TLFB (8.9% men, 3.5% women). The 30-day-AUDITâ¯≥â¯8 had sensitivity 86.7%, 95%CI: 81.8%-90.7% and specificity 90.9%, 95%CI:89.0%-92.6% versus 12-month-AUDITâ¯≥â¯8. Both 30-day and 12-month-AUDITâ¯≥â¯8 were sensitive and specific markers of heavy drinking by PEth (12-month-AUDIT sensitivityâ¯=â¯80.0%; 95%CI:67.0%-89.6%; specificityâ¯=â¯83.3%; 95%CI:81.1%-85.3%). The 30-day-AUDIT was a sensitive and specific marker of binge drinking based on TLFB (sensitivityâ¯=â¯82.7%; 95%CI:72.7%-90.2%, specificityâ¯=â¯79.8%; 95%CI:77.4%-82.1%); 12-month-AUDIT had lower sensitivity. Both 30-day and 12-month AUDITâ¯≥â¯8 were highly specific but insensitive markers of having DSM-5â¯≥â¯2 symptoms. CONCLUSION: Among young people in Uganda, ACASI-administered 30-day and 12-month-AUDIT have good diagnostic properties compared to PEth, DSM-5 and TLFB. Self-reported AUDIT provides a quick and valid means of assessing alcohol misuse in these communities.
RESUMO
BACKGROUND: Less than one quarter of people in need have access to HIV services in Uganda. This study assessed willingness of people living with HIV/AIDS (PLWHAs) to utilize HIV services provided by Village Health Teams (VHTs) in Kalungu district, central Uganda. METHODS: A cross-sectional study conducted in two health facilities providing anti-retroviral therapy enrolled 312 PLWHAs. Pre-tested semi-structured questionnaires were administered to participants at household level. A forward fitting logistic regression model computed the predictors of willingness of PLWHAs to utilize services provided by VHTs. RESULTS: Overall, 49% were willing to utilize HIV services provided by VHTs increasing to 75.6% if the VHT member was HIV positive. PLWHAs who resided in urban areas were more likely to utilize HIV services provided by VHTs (AOR 0.24, 95%CI 0.06-0.87). Barriers to utilizing HIV services provided by VHTs were: income level > 40 USD (AOR 6.43 95%CI 1.19-34.68), being a business person (AOR 8.71 95%CI 1.23-61.72), peasant (AOR 7.95 95%CI 1.37-46.19), lack of encouragement from: peers (AOR 6.33 95%CI 1.43-28.09), spouses (AOR 4.93 95%CI 1.23-19.82) and community leader (AOR 9.67 95%CI 3.35-27.92). CONCLUSION: Social support could improve willingness by PLWHAs to utilize HIV services provided by VHTs for increased access to HIV services by PLWHA.