ABSTRACT

Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes—prospective memory impairment and interactive toxicity beliefs/avoidance behaviors—involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.

摘要

饮酒是抗逆转录病毒疗法 (ART) 依从性最普遍的关联因素之一，但这种关联背后的因果过程在很大程度上仍未得到探索。本系统评价的目的是开发一个概念模型来描述饮酒对 ART 不依从性的因果影响。我们回顾了 230 项研究，这些研究检查了饮酒与 ART 依从性之间的关系，主要目的有三个：(1) 复制和扩展以前的文献回顾，(2) 总结和批判能够回答时间重叠问题的研究设计，以及 ( 3) 总结潜在的作用机制。提出了一种与酒精相关的 ART 不依从性模型来指导未来的工作，整合 ART 依从性的一般理论和关于酒精中毒的心理和行为影响的理论。该概念模型描述了两个机制过程——前瞻性记忆障碍和交互毒性信念/回避行为——分别涉及酒精相关的有意和无意的不依从性。该模型可用于指导未来对饮酒与依从性之间经常观察到的相关性所涉及的因果过程的研究。