Frequent Use of Khat, an Amphetamine-Like Substance, as a Risk Factor for Poor Adherence and Lost to Follow-Up Among Patients New to HIV Care in Ethiopia

Khat, a plant native to East Africa, has amphetamine-like psychoactive constituents, and is a potential risk factor for HIV infection. Chronic use can cause cognitive impairment and other mental disorders, raising concerns about effects on retention and adherence with HIV care. During 2013-2014, 322 Ethiopian patients newly enrolled at HIV clinics in Dire Dawa and Harar were surveyed about khat use and prospectively followed for 1 year; 9% died, 18% transferred care to other clinics, and 22% were lost to follow-up (LTFU) (no clinic visit for >3 months). Of 248 patients who received a 12-month follow-up survey, 37% used khat in the year after enrollment, with a median use of 60h in a typical month. Those using khat 60h/month (median among users) were more likely than others to be LTFU (31% vs. 16%, p=.014); those using khat 150h/month (upper quartile) had 44% LTFU rates versus 16% for others (p=.002). Complete 3-day adherence (taking all doses) of antiretroviral therapy was reported by 77% of those using khat 60h/month versus 95% of all others (p<.001), and 67% of those using khat 150h/month versus 94% of others (p<.001). In two East African cities, where khat use is common, frequent use was a significant risk factor for higher 1-year LTFU and lower self-reported antiretroviral therapy adherence among people living with HIV entering HIV care. Where khat is widely utilized, interventions to promote either nonuse or reduced use are important as part of a comprehensive HIV care package and national HIV strategies.