Adherence to antiretroviral therapy among HIV positive men who inject drugs in Pakistan

Iversen, Jenny; Qureshi, Salman ul H; Zafar, Malika; Busz, Machteld; Maher, Lisa

doi:10.1016/j.drugpo.2021.103281

Cited by 7 publications

(10 citation statements)

References 43 publications

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“…Further, the requirement of individuals actively injecting drugs to undergo a two-week drug detoxification prior to ART initiation (7) and lack of a national opioid substitution therapy program in Pakistan presents structural barriers which might contribute to higher rates of HIV transmission among PWID overall, hindering effective HIV management and posing challenges to overall HIV epidemic control efforts in the country (8)(9)(10). PWID undergoing ART have increased vulnerability to treatment interruptions due to a lack of social support and stable housing, mental health comorbidities, and effects of stigma and discrimination (9,11,12). Suboptimal therapy and non-adherence to ART facilitates the selection of viral strains harboring drug resistance mutations (DRMs) (13) which can be transmitted to ART-naïve individuals, constituting what is defined as transmitted drug resistance (14).…”

Section: Introductionmentioning

confidence: 99%

“…PWID undergoing ART have increased vulnerability to treatment interruptions due to a lack of social support and stable housing, mental health comorbidities, and effects of stigma and discrimination (9,11,12). Suboptimal therapy and non-adherence to ART facilitates the selection of viral strains harboring drug resistance mutations (DRMs) (13) which can be transmitted to ART-naïve individuals, constituting what is defined as transmitted drug resistance (14).…”

Section: Introductionmentioning

confidence: 99%

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Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

Melnychuk,

Thompson,

Archibald

et al. 2024

Preprint

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Transmission of drug-resistant HIV strains to treatment-naïve patients can compromise antiretroviral therapy (ART) effectiveness and lead to treatment failure. In Pakistan, transmitted HIV drug resistance among people who inject drugs (PWID) is fuelled by a lack of ART, poor drug adherence, and unsafe injection practices, resulting in efficient transmission in large injecting networks. A cross-sectional study was conducted among PWID recruited in the Pakistani cities of Karachi, Larkana, Peshawar, Quetta and Hyderabad (August 2014 to January 2015). A portion of the HIV pol gene was amplified from HIV-reactive dried blood spot specimens (n=282/367) and sequenced using an in-house Sanger sequencing assay for HIV drug resistance mutation genotyping. Drug resistance mutations (DRMs) were identified using the Stanford University HIV Drug Resistance Database HIVdb algorithm (https://hivdb.stanford.edu/hivdb). Overall, HIV subtype A1 was dominant (78.0%; n=220), followed by CRF02_AG (15.6%; n=44), CRF35_AD (2.5% n=7), recombinants (3.5%; n=10), and subtype C (0.4% n=1). DRM analysis identified over half (63.8%) of participants harbored at least one DRM, of which 28.9% reported using help from a professional injector. Nearly all (99.4%) participants were not actively receiving ART because most (88.7%) had never undergone HIV testing and were unaware of their status. Findings suggest significant transmitted HIV drug resistance present among PWID, exacerbated by unsafe injection practices, particularly professional injection. Low testing rates signal a need for more comprehensive testing programs to improve HIV status awareness and ART coverage in Pakistan. Given most treatment-naïve participants had evidence of drug resistance, drug resistance genotyping prior to ART initiation might aid in ensuring effective treatment to prevent transmission of resistant HIV strains.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

Melnychuk,

Thompson,

Archibald

et al. 2024

Preprint

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“…10,11 In Pakistan a study also showed around 55% effects of rehabilitation on adherence in PWID. 12 This study was conducted to assess the impact of other perspectives of abstinence and adherence including family support and employment status on a person's willingness for treatment continuation and avoidance of drugs.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 In Pakistan a study also showed around 55% effects of rehabilitation on adherence in PWID. 12 …”

Section: Introductionmentioning

confidence: 99%

The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review

Hussain

Rahim²,

Sheikh³

et al. 2021

Pak J Med Sci

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Background & Objective: HIV/AIDS is mostly seen in people who inject recreational drugs (PWID). Adherence has to be optimum for its treatment to be effective. Compliance to HIV medication has been problematic in PWID making HIV control difficult. Many studies in the past have validated educational activities like rehabilitation programs beneficial in maintaining regularity in medication intake. This brought us to the question of looking at such programs and its effects on our population. This study was conducted to assess the impact of other perspectives of abstinence and adherence including family support and employment status on a person’s willingness for treatment continuation and avoidance of drugs. Methods: A retrospective chart review of 241 PWID was conducted to assess adherence to antiretroviral agents (ARVs) and abstinence from recreational drugs post visit to the rehabilitation center. Associations with family support, marital status, employment, income and back to work status were also assessed. Results: Adherence to ARVs had significant statistical association with marital status (p=0.025), starting work again (p=0.001), family support (p=0.009), employment status (p=0.009) and monthly income (p=0.025). While family support (p=0.033), employment status (p<0.0001), Going back to work (p<0.0001), mode of travel to Rehabilitation center (p<0.0001) and monthly income (p=0.004) were associated with abstinence from drugs. Duration of rehabilitation or age had no effect on adherence or abstinence in our patient population of PWID. Conclusion: Family and spousal support and employment promote optimal ARV compliance and should be encouraged when starting ARVs. Enrollment in a long-term complementing educational program would further enhance ARV intake and abstinence. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 How to cite this:Hussain A, Rahim A, Sheikh A, Jiwani A. The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review. Pak J Med Sci. 2022;38(2):411-416. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…The absence of Opioid Agonist Treatment and other drug rehabilitation programs has made it difficult for HIV-positive users to commit to ART, leading to addiction relapse. 7 In addition to this, the health care seeking behavior of HIV patients has been affected by stereotypes and negative experiences with health care workers. Many HIV patients face hindrances in accepting medical care due to existing social perceptions associated with an AIDS diagnosis.…”

mentioning

confidence: 99%

HIV in Pakistan: Understanding Challenges and Implementing Strategies for Prevention

Ejaz,

Ahmad,

Shahbaz

et al. 2024

Asia Pac J Public Health

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Adherence to antiretroviral therapy among HIV positive men who inject drugs in Pakistan

Cited by 7 publications

References 43 publications

Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review

HIV in Pakistan: Understanding Challenges and Implementing Strategies for Prevention

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