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Megan Grammatico, MD Student


GHES US Fellow 2019-2020

FELLOWSHIP SITE: Philanjalo and Church of Scotland, South Africa
U.S. INSTITUTION: Yale University

Project Title: Impact of Alcohol Use on PrEP Adherence in Rural South Africa

One in five South African adults ages 15-64 is infected with HIV, making the country home to the largest HIV epidemic in the world. Alarmingly, 62.2% of males living with HIV (PLWH) and 45% of female PLWH remain unaware of their HIV status. Alcohol use is emerging as a recognized risk factor for HIV acquisition in sub-Saharan Africa, making alcohol venues, known locally as shebeens, ideal places to engage individuals for testing and prevention. In an ongoing study at the research site in rural South Africa, more than 1300 community members have been screened in a community-based testing program at shebeens. Shebeen patrons report engaging in high-risk HIV behaviors (excess alcohol consumption, lack of condom use) in a high prevalence setting, which makes them an important target population for HIV prevention; in particular, oral pre-exposure prophylaxis (PrEP). Furthermore, substantial data demonstrates the negative impact of alcohol on antiretroviral adherence. The effect that alcohol consumption has on PrEP adherence, however, is currently unknown, making this an important research question.

The proposed study will explore the effect of alcohol use, particularly binge drinking, on PrEP adherence in a young, rural, HIV-negative South African population. Participants reporting high-risk behaviors who test HIV negative at local shebeens will be offered PrEP services in a NGO setting. Participants initiating PrEP will be followed for seven months, with visits at one, four, and seven months. Adherence will be assessed through self-report and tenofovir dried blood spot analyses. Capillary dried blood spot samples will also be collected at participants’ baseline visit to assess for the validated alcohol biomarker Phosphatidyethanol (PEth). I will determine whether baseline AUDIT scores and PEth levels correlate with PrEP adherence (through self-report and tenofovir levels), and whether multivariate regression analysis demonstrates alcohol consumption is an independent contributor to PrEP adherence.