{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:24:15Z","timestamp":1792193055357,"version":"4.4.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.24185.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000}}],"reference-count":48,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["201433"],"award-info":[{"award-number":["201433"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI007433"],"award-info":[{"award-number":["T32AI007433"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K24HL166024"],"award-info":[{"award-number":["K24HL166024"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"crossref","award":["K23MH136873"],"award-info":[{"award-number":["K23MH136873"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"crossref","award":["K24AA022586"],"award-info":[{"award-number":["K24AA022586"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>\n                    Background In South Africa, men experience lower HIV care engagement and retention than women. Men who consume alcohol face greater barriers to care and may represent a population with significant unmet health needs. We investigated associations between alcohol consumption, HIV clinical outcomes, and all-cause mortality among men in rural South Africa. Methods We analyzed data from men in a population-based health screening in KwaZulu-Natal linked to longitudinal clinical and mortality data. Our primary exposure was hazardous alcohol use, defined as an AUDIT-C score \u22654. Our primary outcomes were: living with HIV, awareness of HIV positive status, virologic suppression (&lt;40 copies\/mL), advanced HIV disease (CD4 count&lt;200 cells\/mm\n                    <ns3:sup>3<\/ns3:sup>\n                    ), healthcare access (clinic visit &lt;12 months), and all-cause mortality. Poisson regression models were used for HIV outcomes and clinic follow-up; Cox proportional hazard models were used for mortality. Models were adjusted for clinical and demographic confounders. In sensitivity analyses, alcohol use was redefined as any use in the past 12 months. Results Among 5,771 men (median age 36.2 years, SD 18.9), 10% met criteria for hazardous alcohol use with 28% reporting any alcohol use in the past 12 months. Hazardous alcohol use was not associated with HIV prevalence (aPR 0.96 95%CI 0.83-1.12, p=0.63), awareness of HIV diagnosis (aPR 1.25, 95%CI 0.88\u20131.77, p=0.22), virologic suppression (aPR 0.92, 95%CI 0.82\u20131.03, p=0.14), or advanced HIV disease (aPR 0.71, 95%CI 0.40\u20131.26, p=0.24). Clinic retention was low overall (56% hazardous alcohol vs. 63% no\/low-risk alcohol, p=0.092) and similar between groups in adjusted models. Over a median 3.4 years, 7.3% of men with HIV died, with no differences by hazardous alcohol use. Results were similar when considering any alcohol use as the exposure. Conclusions Hazardous alcohol use among rural South Africa men was not associated with HIV prevalence, HIV clinical outcomes, retention in care, or short-term mortality.\n                  <\/ns3:p>","DOI":"10.12688\/wellcomeopenres.24185.2","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T03:24:05Z","timestamp":1769484245000},"page":"469","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Alcohol Consumption and Health Outcomes Among Men in a Rural HIV-Endemic Cohort in South Africa"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7752-6236","authenticated-orcid":false,"given":"Alison C.","family":"Castle","sequence":"first","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Division of Infectious Diseases Boston Massachusetts Massachusetts General Hospital"},{"name":"Boston Massachusetts Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheela V.","family":"Shenoi","sequence":"additional","affiliation":[{"name":"New Haven Connecticut Yale University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kobus","family":"Herbst","sequence":"additional","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Durban University of KwaZulu-Natal"},{"name":"Durban DSI-SAMRC South African Population Research Infrastructure Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4755-5380","authenticated-orcid":false,"given":"Emily B.","family":"Wong","sequence":"additional","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Durban University of KwaZulu-Natal"},{"name":"Division of Infectious Diseases Birmingham Alabama The University of Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2962-3992","authenticated-orcid":false,"given":"Thumbi","family":"Ndung'u","sequence":"additional","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Durban University of KwaZulu-Natal"},{"name":"Division of Infection and Immunity London England University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem","family":"Hanekom","sequence":"additional","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Durban University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith A.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Division of HIV, ID, & Global Medicine San Francisco California University of California San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3506-842X","authenticated-orcid":false,"given":"Mark J.","family":"Siedner","sequence":"additional","affiliation":[{"name":"Durban KwaZulu-Natal 3935 Africa Health Research Institute"},{"name":"Division of Infectious Diseases Boston Massachusetts Massachusetts General Hospital"},{"name":"Boston Massachusetts Harvard Medical School"},{"name":"Durban University of KwaZulu-Natal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Vukuzazi Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"169","DOI":"10.12688\/wellcomeopenres.16702.2","article-title":"Can we find the missing men in clinics? 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We have addressed each comment in detail below and revised the manuscript accordingly. \n<b>Comment 1:<\/b> In the second to last paragraph of the introduction, please elaborate on the novelty of this study as it relates to alcohol research in this population. What is new about this study, and why focus on alcohol based on the literature? Given the findings, providing a stronger rationale for focusing on alcohol would be beneficial\n<i>.<\/i> \n<b>Response: <\/b>Thank you for this suggestion. We revised the 2\n<sup>nd<\/sup> to last paragraph of the introduction to clarify the novelty of this analysis, noting that much of the existing alcohol\u2013HIV literature is based on clinic-based or cross-sectional studies conducted prior to the widespread use of integrase inhibitor\u2013based ART. We highlight that because these regimens (TLD) achieve rapid viral suppression and have higher barriers to resistance, the clinical consequences of intermittent nonadherence associated with alcohol use may differ in the current ART era. The novelty of this study lies in leveraging linked, population-based longitudinal data from a setting where modern ART has been widely rolled out. We also strengthened the rationale for focusing on alcohol by expanding the preceding paragraph to more clearly situate hazardous alcohol use, based on the literature, as a driver of elevated HIV risk, delayed care engagement, and poorer health outcomes among men. \n<b>Comment 2: <\/b>For the sentence: \u201cOverall, fewer than two-thirds of men stayed connected to healthcare after screening, regardless of whether they drank alcohol.\u201d Please clarify whether this refers to the binary any alcohol variable or the AUDIT categorical variable. \n<b>Response: <\/b>Thank you for noting this ambiguity. We have clarified that this finding was consistent across both alcohol exposure definitions. Specifically, fewer than two-thirds of men attended a clinic visit within 12 months after screening regardless of whether alcohol use was defined as hazardous alcohol use (AUDIT-C \u22654) or as any alcohol consumption in the past 12 months. \n<b>Comment 3:<\/b> The covariates and statistical analysis sections repeat information about covariates. Please keep these details in the covariates section and avoid repetition in the analysis section. \n<b>Response:<\/b> The full description and justification of covariates now appears only in the covariates subsection and the statistical analysis section now refers back to this list without restating it. \n<b>Comment 4:<\/b> The final sentence may overreach: \u201cThese findings suggest that while alcohol use is common, it may not directly impact HIV outcomes.\u201d Evidence suggests alcohol can directly impact outcomes even with ART adherence. Please consider reframing and suggesting mediation analyses. \n<b>Response:<\/b> We appreciate this important point. We have revised this section to avoid overstatement and instead emphasize the relationship is more complex in the modern ART era and require further mediation analyses.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-469\/v2#referee-comment-6378","order":1,"name":"referee-comment-6378","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.28489.r152717, Veysel Akca, Mu\u011fla University, Mu\u011fla, 23 Apr 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-469\/v2#referee-response-152717","order":2,"name":"referee-response-152717","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Wellcome [201433]; National Institute of Allergy and Infectious Diseases [T32 AI007433]; the National Heart, Lung, Blood Institute [K24 HL166024]; the National Institute of Mental Health [K23 MH136873]; and the National Institute on Alcohol Abuse and Alcoholism [K24 AA022586] of the National Institutes of Health. \r\nFor the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}