Modeling reductions in harmful alcohol use on HIV transmission and mortality in the era of universal test and treat in Uganda

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Abstract The World Health Organization (WHO) recommends that all people with HIV (PWH) initiate ART and countries in Sub-Saharan Africa (SSA) have started to roll-out a universal test and treat (UTT) strategy. 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. My proposed 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 address both burdens by reducing harmful alcohol use. My research will assess the value for money of investing in alcohol use interventions to reduce HIV transmission in the era of UTT in Uganda. This project will improve understanding of the relationship between harmful alcohol use and the HIV epidemic through the following aims: 1) Estimate the prevalence of harmful alcohol use and relationships with receipt of ART and viral load suppression in the era of UTT in Uganda 2) Quantify the contribution of harmful alcohol use to HIV transmissions and mortality in Uganda during the UTT era, using infectious disease modeling. 3) Determine the cost-effectiveness of alcohol reduction interventions to prevent HIV transmission, in Uganda. The candidate, Dr. Adriane Wynn, is well qualified to conduct this research because of her strong background in quantitative methods and track record of publications and successful grant writing. Over the 5-year award period, Dr. Wynn will achieve the following career development objectives: 1) Develop expertise in the epidemiology and intersection of alcohol use and HIV and alcohol reduction interventions in the era of UTT in Sub-Saharan Africa. 2) Gain skills in modeling the population impact of alcohol use on HIV transmission and disease progression. 3) Acquire expertise in health economic evaluation of alcohol reduction interventions incorporating HIV transmission prevention benefits. 4) Obtain expertise in the ethical conduct of research pertaining to alcohol-using populations and those at risk for or living with HIV. 5) Expand professional development skills in preparation for a successful academic career by further developing skills in grantsmanship, publication, and scientific collaborations. These aims are in line with the Office of AIDS Research high priority topics: “Reducing Incidence of HIV/AIDS” and the NIAAA’s Strategic Plan.