Engagement in Mental Health Care is Associated with Higher Cumulative Drug Exposure and Adherence to Antiretroviral Therapy

Coyle, Ryan P; Schneck, Christopher D.; Morrow, Mary; Coleman, Stacey S; Gardner, Edward M.; Zheng, Jia‐Hua; Ellison, Lucas; Bushman, Lane R.; Kiser, Jennifer J.; MaWhinney, Samantha; Anderson, Peter L.; Castillo‐Mancilla, José

doi:10.1007/s10461-019-02441-8

Cited by 20 publications

(11 citation statements)

References 42 publications

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“…Second, individuals with lower socioeconomic status relative to those with high socioeconomic status living within the same area could become more prone to suboptimal adherence due to an inability to access adequate healthcare (including financial constraints, limited transportation, inflexible employers, among other challenges) [ 12 ]. This finding is supported by another study from our cohort in which PWH with a mental health disorder who were engaged in mental healthcare had higher adherence (both by TFV-DP in DBS and self-report) than PWH with a mental health disorder who were not engaged in mental healthcare, and comparable adherence to PWH without a mental health disorder [ 18 ]. Thus, having access to support services positively impacted adherence.…”

Section: Discussionsupporting

confidence: 86%

“…Log-transformed TFV-DP concentrations were analyzed using a mixed-effects model to estimate the percentage change in drug concentrations for every significant change in the SDoH. We initially evaluated a model in which each individual SDoH (ie, household income, percent living in poverty, education level and income inequality) was the primary predictor of interest, and then we evaluated a model that adjusted for potential confounders that were selected a priori, including age, gender, race, body mass index (BMI), type of ART anchor drug class (nonnucleoside-based, boosted protease inhibitor-based, integrase inhibitor-based or multiclass), estimated glomerular filtration rate ([eGFR] calculated using the Modification of Diet in Renal Disease [MDRD] equation), CD4 + T-cell count, and hematocrit (HCT), as previously described in our cohort [ 1 , 2 , 18 , 19 ]. Model results are presented as percentage change (95% confidence interval [CI]) in TFV-DP concentrations in DBS for every significant change in each SDoH.…”

Section: Methodsmentioning

confidence: 99%

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Income Inequality Is Associated With Low Cumulative Antiretroviral Adherence in Persons With Human Immunodeficiency Virus

Vernon

Morrow

MaWhinney

et al. 2020

Open Forum Infectious Diseases

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Background The adherence biomarker tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is associated with viral suppression and predicts future viremia. However, its association with social determinants of health (SDoH) in people with HIV (PWH) remains unknown. Methods DBS for TFV-DP were longitudinally collected from a clinical cohort of PWH receiving tenofovir disoproxil fumarate (TDF)-based therapy (up to 3 visits over 48-weeks) residing in five Colorado counties. To assign SDoH, zip codes at enrollment were matched with SDoH data from AIDSVu (https://aidsvu.org/). SDoH included household income, percent living in poverty, education level and income inequality (quantified using Gini coefficient, where 0 and 1 represent perfect income equality and inequality, respectively). Log-transformed TFV-DP concentrations were analyzed using a mixed-effects model to estimate percent change [95% CI] in TFV-DP for every significant change in the SDoH and adjusted for relevant covariates including age, gender, race, eGFR, BMI, hematocrit, CD4 + T-cell count, antiretroviral drug class and three-month self-reported adherence. Results Data from 430 PWH totaling 950 person-visits were analyzed. In an adjusted analysis, income inequality was inversely associated with TFV-DP in DBS. For every 0.1 increase in the Gini coefficient, TFV-DP concentrations decreased by 9.2% [-0.5, -17.1; P=0.039]. This remained significant after adjusting for HIV viral suppression, where a 0.1 increase in Gini was associated with a decrease of 8.7% [-0.3, -17.9; P=0.042] in TFV-DP. Conclusions Higher income inequality was associated with lower cumulative antiretroviral adherence. These findings support the need for further research on how SDoH impact adherence and clinical care.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Income Inequality Is Associated With Low Cumulative Antiretroviral Adherence in Persons With Human Immunodeficiency Virus

Vernon

Morrow

MaWhinney

et al. 2020

Open Forum Infectious Diseases

Self Cite

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“…Mental health care engagement is associated with increased retention in HIV care, 46 , 47 higher ART adherence and virological suppression, 48 and decreased mortality. 47 , 49 Approximately one in five adults in the United States experience mental health challenges in a given year; however, only 41% of them will receive mental health services.…”

Section: Discussionmentioning

confidence: 99%

Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV

Saberi

McCuistian

Agnew

et al. 2021

Telemedicine Reports

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Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20–30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18–29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: “I felt heard, understood, and respected by the counselor.” In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: “Overall, today's session was right for me.” At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ID: NCT03681145

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“…Among the available measures of ART adherence are self‐report, pharmacy refills, electronic monitoring, directly observed therapy (DOT), electronic pill boxes, and pharmacologic biomarkers, such as drug concentrations in urine, hair, and dried blood spots (DBS) 7 . Previous research on tenofovir diphosphate (TFV‐DP) in DBS, a measure of cumulative ART adherence and exposure in PWH taking tenofovir‐based regimens, has demonstrated that this adherence biomarker is strongly associated with viral suppression, is predictive of future viremia, and is influenced by several biological, demographic, and social factors 1,8–11 . Despite the potential simplicity of ART, PWH may be taking numerous additional medications, including over‐the‐counter (OTC) agents, which can increase the burden on medication adherence.…”

Section: Introductionmentioning

confidence: 99%

Higher medication complexity in persons with HIV is associated with lower tenofovir diphosphate in dried blood spots

et al. 2021

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Study Objective To assess the association between tenofovir diphosphate (TFV‐DP) in dried blood spots (DBS), a measure of cumulative tenofovir‐based antiretroviral (ART) adherence, with medication regimen complexity in persons with human immunodeficiency virus (PWH). Design Prospective clinical cohort (up to three visits over 48 weeks). Setting Academic‐based HIV clinic. Patients PWH receiving tenofovir disoproxil fumarate (TDF)‐based ART. Measurements DBS for TFV‐DP were collected at every study visit. Baseline patient‐level medication regimen complexity index (pMRCI) scores were calculated and categorized into three sub‐scores (disease‐specific [ART], non‐ART, and over‐the‐counter [OTC]). The pMRCI scores were evaluated to assess the association with TFV‐DP in DBS <350 fmol/punch after adjusting for clinical covariates. pMRCI scores were also categorized to estimate the adjusted relative risk (aRR) of having a TFV‐DP <350 fmol/punch between pMRCI quartiles. Main Results Data from 525 participants (1,146 person‐visits) were analyzed. Baseline median (interquartile range [IQR]) pMRCI scores for participants with TFV‐DP in DBS <350 vs. ≥350 fmol/punch were 4 (3, 8) vs. 4 (2, 6) for ART, 27 (12, 31) vs. 12 (5, 22) for non‐ART, and 0 (0, 1) vs. 0 (0, 2) for OTC, respectively. For the non‐ART scores, the aRR for having a TFV‐DP in DBS <350 fmol/punch was 6.4 (95% CI: 2.0, 20.6; P=0.002) when comparing participants in the highest pMRCI quartile with those in the lowest quartile. Conclusions Higher pMRCI for non‐ART medications is associated with lower adherence as measured by TFV‐DP in DBS. Future research should investigate whether reducing non‐ART medication complexity improves ART adherence and exposure in PWH.

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Engagement in Mental Health Care is Associated with Higher Cumulative Drug Exposure and Adherence to Antiretroviral Therapy

Cited by 20 publications

References 42 publications

Income Inequality Is Associated With Low Cumulative Antiretroviral Adherence in Persons With Human Immunodeficiency Virus

Income Inequality Is Associated With Low Cumulative Antiretroviral Adherence in Persons With Human Immunodeficiency Virus

Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV

Higher medication complexity in persons with HIV is associated with lower tenofovir diphosphate in dried blood spots

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