Modeling Reductions in Harmful Alcohol Use on HIV Transmission and Mortality in the Era of Universal Test (K01AA027733)

WHY?

The World Health Organization (WHO) recommends that all people living with HIV (PLWH) initiate ART and countries in sub-Saharan Africa (SSA) have rolled out a universal test and treat (UTT) strategy. Some recent trials have shown that expanded treatment does not always result in reduced HIV incidence at the population level. Questions remain on the role of underlying factors that may reduce the benefits of UTT and drive the HIV epidemic. According to a recent UNAIDS report, alcohol use is an overlooked factor in the HIV epidemic that requires greater attention. Alcohol use increases HIV risk through sexual behaviors and reducing uptake and adherence to ART. Thus, alcohol use may contribute to population-level failure to achieve HIV elimination targets. This research will estimate the long-term, population impact of harmful alcohol use on HIV transmission and mortality in the UTT era in Uganda. Uganda has one of the highest levels of alcohol use per capita in SSA and has a generalized HIV epidemic, with a prevalence of 5.7%. The UTT strategy took effect in Uganda in 2017. However, in 2019, 22% of PWH in Uganda were not on ART and 36% were not virally suppressed. Uganda has an opportunity to address both burdens by reducing harmful alcohol use. This research will assess the value for money of investing in alcohol use interventions to reduce HIV transmission in the era of UTT in Uganda.