University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Background: Mental health disorders are the number one comorbidity among people with HIV (PWH). Alcohol use disorders are also very common among this group, with almost half of PWH classified as hazardous drinkers. However, research on the interrelationship between alcohol use, mental health disorders and their effects on HIV outcomes among PWH with hazardous alcohol use remains scarce. Methods: I conducted three studies using data from a randomized controlled trial in Thai Nguyen, Vietnam, which aimed to evaluate the effects of a combined intervention and a brief intervention drawing from Motivational Enhancement Therapy and Cognitive Behavioral Therapy on alcohol use and viral suppression among antiretroviral therapy (ART) clients with hazardous alcohol use. In study 1, I evaluated the longitudinal associations between mental health symptoms (depression and anxiety symptoms) and two HIV outcomes (viral suppression and complete ART adherence) among participants, and determined whether alcohol dependence modified these associations. In study 2, I described the changes in depression and anxiety symptoms of participants over time and assessed the impact of the combined and brief interventions on depression and anxiety symptoms, comparing the effects of these interventions to each other and to the standard of care (SOC) group. Finally, in study 3, I examined whether alcohol use mediated the pathway from the interventions to depression and anxiety symptoms of participants. Results: In study 1, depression and anxiety symptoms were associated with a lower probability of complete ART adherence, although they had no overall effect on viral suppression. Alcohol dependence was a significant effect modifier, such that the negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. In study 2, depression and anxiety symptoms were common at baseline, and decreases in depression and anxiety symptoms were observed in all three arms over time. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. In study 3, alcohol use, measured as percentage of days abstinent from alcohol in the last 30 days, was a significant mediator of the pathways from two alcohol interventions to depression symptoms, but not anxiety symptoms.Conclusions: Improving mental health should be an important target of future interventions for people living with HIV with hazardous alcohol use, and mental health components should be incorporated into alcohol reduction interventions to simultaneously target these co-morbidities among PWH.Doctor of Public Healt
