Antiretroviral Drug Diversion Links Social Vulnerability to Poor Medication Adherence in Substance Abusing Populations

Abstract

Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen Behavioral Model of Health Care Utilization for Vulnerable Populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n=503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25% of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

How and to what extent can pensions facilitate increased use of health services by older people: evidence from social pension expansion in rural China

“…In this study, gender, education level, and living alone were considered as predisposing factors [ 48 – 51 ]. The single enabling factor included was household disposable income per capita per year [ 48 – 50 ]. The need factors included: Activities of Daily Living (ADL) index, self-rated health status, whether the patient reported body pains and whether they had been diagnosed with a chronic condition [ 48 – 50 , 52 , 53 ].…”

Substance Use Disorders, Violence, Mental Health, and HIV: Differentiating a Syndemic Factor by Gender and Sexuality

“…Data were collected from a sample of vulnerable, substance-using PLWH in South Florida between 2010 and 2012 (n=503) – details described elsewhere (10, 54). Recruitment was guided by targeted sampling – a method used to recruit hard-to-reach populations – in geographic areas with high HIV prevalence and poverty indices (55).…”

How and to What Extent Can Pensions Facilitate Increased Use of Health Services by Older People: Evidence From Social Pension Expansion in Rural China

“…This model suggests that health service utilization for an individual is a function of a predisposition to use health services, factors that enable or impede such use, and the need for care [41,45]. In this study, gender, education level, and living alone were considered as predisposing factors [46][47][48][49]. The single enabling factor included was household disposable income per capita per year [46][47][48].…”

“…In this study, gender, education level, and living alone were considered as predisposing factors [46][47][48][49]. The single enabling factor included was household disposable income per capita per year [46][47][48]. The need factors included…”