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

Alan R. Lifson, Sale Workneh, Tibebe Shenie, Desalegn Admassu Ayana, Zenebe Melaku, Lemlem Bezabih, Hiwot Tekle Waktola, Behailu Dagne, Rose Hilk, Ken C. Winters, Lucy Slater

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 60 h in a typical month. Those using khat ≥60 h/month (median among users) were more likely than others to be LTFU (31% vs. 16%, p = .014); those using khat ≥150 h/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 ≥60 h/month versus 95% of all others (p < .001), and 67% of those using khat ≥150 h/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.

Original languageEnglish (US)
Pages (from-to)995-998
Number of pages4
JournalAIDS Research and Human Retroviruses
Issue number10
StatePublished - Oct 2017

Bibliographical note

Funding Information:
Funding for this project was provided by the National Institute of Drug Abuse, National Institutes of Health, grant number: 1R21DA033131-01A1. The authors wish to thank the following: Dil Chora Referral Hospital in Dire Dawa, Hiwot Fana Teaching Hospital in Harar (associated with Haramaya University), the Dire Dawa Regional Health Bureau, Haramaya University, the National Alliance for State and Territorial AIDS Directors, and all of the HIV patients who participated in this study.

Publisher Copyright:
© Copyright 2017, Mary Ann Liebert, Inc. 2017.


  • Ethiopia
  • HIV
  • adherence
  • khat
  • retention


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