Clinical ScienceUnhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern UgandaMuyindike, Winnie R. MBChB, MMEDa,b; Fatch, Robin MPHc; Cheng, Debbie M. ScDd; Emenyonu, Nneka I. DrPH, MPHc; Forman, Leah MPHd; Ngabirano, Christine BA(SS), MPHa; Adong, Julian MBChB, MMEDa; Linas, Benjamin MD, MPHe; Jacobson, Karen R. MD, MPHe; Hahn, Judith A. MA, PhDc Author Information aMbarara University of Science and Technology, Mbarara, Uganda; bMbarara Regional Referral Hospital, Mbarara, Uganda; cUniversity of California, San Francisco, San Francisco, CA; dBoston University School of Public Health, Boston, MA; and eBoston Medical Center, Boston, MA. Correspondence to: Winnie R. Muyindike, MBChB, MMED, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara Uganda (e-mail: [email protected]). This study was funded by NIH/NIAAA U01 AA020776 (PI: J.A.H.), NIH/NIAAA K24 AA022586 (PI: J.A.H.), and NIH/NIAAA U24AA020779 (PI: D.M.C.) The authors have no conflicts of interest to declare. The data sets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author and/or the senior author (J.A.H.: [email protected]) on reasonable request. JAIDS Journal of Acquired Immune Deficiency Syndromes 91(5):p 460-468, December 15, 2022. | DOI: 10.1097/QAI.0000000000003082 Buy Metrics Abstract Background: Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known. Methods: This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as <90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1–2 (women) or 1–3 (men) and/or PEth 8 ≥ 50 ng/mL; and unhealthy: AUDIT-C ≥3 (women) or ≥4 (men) and/or PEth ≥50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence. Results: Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption. Conclusions: Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.