Browsing by Author "Myers, B."

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    Characteristics and drinking behaviour of patients on antiretroviral therapy who drink and attend HIV clinics in Tshwane, South Africa : implications for intervention
    (South African Medical Association, 2019-09-30) Parry, C. D.; Londani, M.; Shuper, P. A.; Myers, B.; Kekwaletswe, C. T.; Nkosi, S.; Morojele, N. K.
    Background. Patients on antiretroviral therapy (ART) who drink alcohol are at risk of poor medication adherence and negative health outcomes. Objectives. To explore the drinking behaviour of patients on ART and assess the associations between drinking, adherence to ART and viral load, and in particular factors associated with binge drinking (≥6 drinks per occasion) at least monthly. Methods. We recruited 623 HIV patients from six hospitals in the Tshwane metropole who scored positive on the Alcohol Use Disorders Identification Test (AUDIT-C) but were ‘non-dependent’ drinkers into a randomised controlled trial. This article reports on baseline data. Results. Of the patients, 51% reported drinking in the past week, 60% of men and 33% of women consumed ≥6 standard drinks on a typical drinking day, and 19% of men and 5% of women were identified as drinking at harmful levels. Over a quarter reported having a friend or relative, or a doctor or other healthcare worker, express concern about their drinking or suggest that they cut down. AUDIT total scores were significantly negatively correlated with self-reported adherence to ART and positively correlated with viral load. Number of years on ART was not significantly associated with binge drinking. Persons who were employed part time (odds ratio (OR) 1.474) or were self-employed (OR 2.135) were more likely to binge-drink than unemployed persons. Beer drinkers (OR 1.716) were more at risk for binge drinking than non-beer drinkers, and persons who drank monthly or less (OR 0.053) or 2 - 4 times a month (OR 0.168) were less at risk for bingeing than those who drank ≥4 times per week. Conclusions. The high volume of alcohol consumed per occasion by patients on ART, especially beer and spirits drinkers, is a concern. Interventions that address structural drivers of heavy drinking and target HIV patients at risk of heavy drinking are needed.
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    The impact of alcohol use on tuberculosis treatment outcomes : a systematic review and meta-analysis
    (International Union Against Tuberculosis and Lung Disease, 2020-01) Ragan, E. J.; Kleinman, M. B.; Sweigart, B.; Gnatienko, N.; Parry, C. D.; Horsburgh, C. R.; LaValley, M. P.; Myers, B.; Jacobson, K. R.
    Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980–May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57–2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73–2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.
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    Looking back, moving forward : 50 years of South African Medical Research Council alcohol-related publications
    (Health & Medical Publishing Group, 2019-12-05) Parry, Charles David Heber; Myers, B.; Matzopoulos, R.; Morojele, N.; Siegfried, N.
    Background. Alcohol is one of the highest risk factors for death and disability in South Africa (SA). Objective. To explore the trajectory of empirical research on alcohol in SA between 1969 and 2019, with an emphasis on South African Medical Research Council (SAMRC) authored publications. Methods. We reviewed published research (Pubmed and Africa-Wide Information) using systematic methods, clear inclusion and exclusion criteria, and defined search terms. The search was not limited by language. Data synthesis was carried out by the first and last authors. Results. A total of 867 journal articles met the inclusion criteria, with 243 (28.0%) authored or co-authored by SAMRC researchers. For the latter group, three-quarters had an SAMRC researcher as first or last author. Over three-quarters (78.6%) of the SAMRC author positions (‘first’, ‘last’ or ‘other, counting researchers from a unit only once, but counting authors across different units on a single publication) were from intramural units. Over half the articles authored by SAMRC researchers focused on non-communicable diseases (55.9%), 23.8% focused on communicable diseases, and 10% on crime, violence or injury. Few articles focused on alcohol and tuberculosis (TB), alcohol and cancer, or alcohol policy. Over three-quarters (76.9%) were epidemiological in nature, and 65.3% were cross-sectional studies. There were 17 reviews (7 systematic) and 11 randomised controlled trials (RCTs). There was an increase in the annual number of publications over the 50-year period for both SAMRC and non-SAMRC researchers. Over time, there has been a trend towards publishing on alcohol research in journals published outside SA, but the SAMJ still remains a popular journal choice. Conclusion. The SAMRC has contributed substantially to the growing field of alcohol research in SA, but gaps in areas such as alcohol policy evaluation, alcohol and its association with TB and cancer, and interventional research, are evident.
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    A novel brief treatment for methamphetamine use disorders in South Africa : a randomised feasibility trial
    (BioMed Central, 2021-01-07) Sorsdahl, K.; Stein, D. J; Pasche, S.; Jacobs, Y.; Kader, R.; Odlaug, B.; Richter, S.; Myers, B.; Grant, J. E.
    Background: Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD. Methods: We enrolled 60 adults with a MAUD and randomly assigned them 1:1 to the IDMI intervention delivered by clinical psychologists and a control group who we referred to usual care. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, were calculated. Follow-up interviews were conducted at 6 weeks and 3 months post-enrollment. Results: Over 9 months, 278 potential particiants initiated contact. Following initial screening 78 (28%) met inclusion criteria, and 60 (77%) were randomised. Thirteen of the 30 participants assigned to the treatment group completed the intervention. Both psychologists were highly adherent to the intervention, obtaining a fidelity rating of 91%. In total, 39 (65%) participants completed the 6-week follow-up and 40 (67%) completed the 3-month follow-up. The intervention shows potential effectiveness in the intention-to-treat analysis where frequency of methamphetamine use was significantly lower in the treatment than in the control group at both the 6 week and 3-month endpoints. No adverse outcomes were reported. Conclusions: This feasibility trial suggests that the locally adapted IDMI intervention is an acceptable and safe intervention as a brief treatment for MAUD in South Africa. Modifications to the study design should be considered in a fully powered, definitive controlled trial to assess this potentially effective intervention.