Prevalence and effects of alcohol and substance use on HIV clinical outcomes in a clinic-based cohort in South Africa

Abstract Alcohol and other substance use (AoSU) are associated with worse HIV outcomes in many settings, but there is limited data from South Africa. In a prospective clinic-based cohort (N = 2376) of people living with HIV (PLWH) in South Africa, we determined the prevalence and correlates of AoSU at entry (use in the last 30 days) with outcomes in the first 12 months of care. Alcohol use was more common among men (50%) than women (33%). Other substance use was uncommon (6%). Alcohol and substance use were not associated with ART initiation (ORalcohol 0.91, p = 0.34; ORsubstance 1.4, p = 0.14). Alcohol use was associated with significantly lower odds of being retained in HIV care (aOR 0.70, 95%CI 0.55–0.90). Non-marijuana substance use was associated with lower odds of viral suppression (aOR 0.35, 95%CI 0.12–1.01). Further quantification of AoSU among PLWH in South Africa are needed to implement appropriate interventions to reduce harms from AoSU.