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This study assessed the prevalence and factors associated with alcohol use and risky alcohol use among adults living with HIV in Dar-es-Salaam, Tanzania. This cross-sectional study included data from 771 adults living with HIV on antiretroviral therapy (ART) who were enrolled in a non-inferiority cluster randomized controlled trial. Alcohol use and risky drinking in the past 12 months were assessed using the Alcohol Use Disorders Identification Test (AUDIT-C) tool. Log-binomial regression models were applied to identify factors associated with alcohol use and risky alcohol use. Overall, 31.4% of participants reported current alcohol use (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009242). Among these individuals, 45.5% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009110) engaged in risky alcohol use (14.2% among all participants). About a quarter (23.2%) were classified as engaging in heavy episodic drinking (HED). In multivariable models, older adults (RR\u2009=\u20090.27; 95%CI: 0.13\u20130.54) and males (RR\u2009=\u20090.68; 95%CI: 0.46\u20131.01) had a lower risk of risky alcohol use. Individuals who had disclosed their status to their partners were more likely to report risky alcohol use compared to those who had not disclosed (RR\u2009=\u20091.33; 95%CI:1.00\u20131.78). These findings indicate that alcohol use is common among adults living with HIV, with half of current drinkers engaging in risky consumption patterns, including HED. Risky alcohol use was more prevalent among younger adults and women. These results underscore the need for targeted interventions addressing risky alcohol use within primary HIV care settings, particularly for young adults and women.\n                  <\/jats:p>","DOI":"10.1007\/s10461-026-05094-6","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:52:34Z","timestamp":1773136354000},"page":"3008-3017","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alcohol Use, Risky Alcohol Use, and Associated Factors Among Adults Living with HIV in Urban Dar es Salaam, Tanzania"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8312-0643","authenticated-orcid":false,"given":"Belinda J.","family":"Njiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackline E.","family":"Ngowi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel M.","family":"Francis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Geldsetzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaie W.","family":"Fawzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Bakari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Sudfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno F.","family":"Sunguya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"5094_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-019-0997-0","author":"J Rehm","year":"2019","unstructured":"Rehm J, Shield KD. 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