TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background: Alcohol use disorder (AUD) is highly prevalent among people who inject drugs (PWID) and it significantly hinders the effectiveness of HIV treatment. Hazardous drinking is mostly associated with viral non-suppression, poor antiretroviral therapy (ART) adherence, and poor retention to care, especially in Eastern Europe and Central Asia (EECA), where structural barriers, fragmented health systems, and stigma limit access to integrated services. Despite the combined burden of HIV and AUD, the utilization of alcohol treatment services among PWID is critically low in Georgia.

Aim: To synthesize regional and global evidence on the relationship between alcohol use disorder and HIV-related outcomes, identify determinants and barriers of AUD service utilization among PWID, and evaluate opportunities for integrating AUD interventions into HIV and harm-reduction programs in Georgia and the EECA region.

Methods: We conducted a narrative review of regional and global literature published between 2000 and 2025, using Scopus, PubMed and Google Scholar. Study eligibility was based on whether selected studies examined the relationship between alcohol use and HIV-related outcomes and/or determinants of alcohol treatment utilization, with focus on PWID. Andersen’s Behavioral Model of Health Services Use, complemented by the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework, was used to thematically synthesize the evidence. Findings were triangulated with unpublished Georgian quantitative data (IBBS 2017–2022).

Results: Perceived need for treatment emerged as the strongest predictor of AUD service utilization across studies, exceed ing clinical and demographic factors. Dominant barriers were criminalization, stigma, denial, limited behavioral health capacity and poor service integration. Consistent evidence indicates that alcohol use was associated with a double risk of ART non adherence and viral non-suppression. Evidence supports the feasibility and effectiveness of integrating SBIRT and task shifted, peer-led interventions into HIV and harm-reduction services.

Conclusions: AUD substantially compromises HIV care outcomes among PWID; however, it remains underdiagnosed and undertreated. Integrating alcohol screening and intervention into HIV and harm-reduction programs, reducing stigma, and strengthening the behavioral health workforce are essential system-level priorities. In Georgia and across EECA, embedding SBIRT within routine HIV services could significantly improve ART adherence, viral suppression, and progress toward UN-AIDS 95-95-95 targets.

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