Depression, substance use, viral load, and CD4+ count among patients who continued or left antiretroviral therapy for HIV in St. Petersburg, Russian Federation

Abstract

Antiretroviral therapy (ART) became more widely available in the Russian Federation in 2006 when the Global Fund made a contribution to purchase ART with a mandate to increase numbers of patients receiving it. Funds were distributed to AIDS Centers and selected hospitals, and numbers quickly increased. Though ART is highly effective for adherent patients, dropout has been a problem; thus understanding characteristics of patients who remain on ART vs. those who leave treatment may provide information to facilitate engagement. We retrospectively assessed depression, hopelessness, substance use, viral load, and CD4+ counts of 120 patients who dropped out of ART for >12 months (Lost-to-Care; LTCs) and 120 who continued for >12 months (Engaged-in-Care; EICs). As expected, LTCs had higher viral loads and depression, lower CD4+ counts, and more alcohol, heroin, and injection drug use in the past 30 days. A binary logistic regression with Center for Epidemiologic Studies Depression score, Beck Hopelessness score, whether drugs/alcohol had ever prevented them from taking ART, and past 30 days’ alcohol use [X2(4)=64.27, p=.0.000] correctly classified 74.5% of participants as LTC or EIC, suggesting that integrated treatment for substance use, psychiatric, and HIV could reduce dropout and improve outcomes.

The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review

“…Thirty-three studies focused on alcohol use and ART adherence [19–26, 27•, 28–49, 50•, 51], and 17 targeted viral suppression [21, 25, 33, 35, 50•, 51–53, 54•, 55–62]. Fewer studies, however, focused on the early stages of the cascade with only three examining the association on HIV diagnosis [63, 64, 65•], two on linkage to care [24, 66], four on retention in care [55, 66–68], and seven on ART initiation [24, 54•, 59, 60, 69–71]. …”

“…Importantly, most of the studies reported in this review are from countries with a moderate level of annual drinking per capita (9 to 11 L). With the exception of one study from Russia [68], almost none of the studies were from countries with the highest levels of consumption. In such settings, it will be crucial to not only examine the impact of AUDs on the HIV continuum of care but to also design targeted or structured interventions to reduce problematic alcohol use (e.g., higher taxation for alcohol, increased legal sanctions for intoxication, social marketing campaigns, etc.).…”

“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

“…Siloed HIV and addiction care systems in the country further hinder connection to HIV care, with patients describing this fragmentation as prohibitive and demoralizing. Case management and patient navigation can connect separated health care systems (Mugavero, Norton, & Saag, 2011; Pecoraro et al, 2015) and facilitate engagement with HIV care (Bradford, Coleman, & Cunningham, 2007; Gardner et al, 2005). Such an approach was shown promising in pilot research from Russia (Shaboltas et al, 2013).…”

Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care

“…Indeed, the presence of psychiatric symptoms has been found to be associated with adherence to HIV care appointments 13,22,23 and ART 24–27 among PLWH who are RIC. Although psychiatric symptoms appear to be an important consideration when understanding HIV care retention, little is currently known about psychiatric symptoms among PLWH who are LTC.…”