HIV-Infected Individuals Who Delay, Decline, or Discontinue Antiretroviral Therapy: Comparing Clinic- and Peer-Recruited Cohorts

Abstract

A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or discontinue antiretroviral therapy (ART) when it is medically indicated (40–45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012–2013. Participants were engaged in structured 1-h assessments with reliable/valid measures on barriers to ART. We found that recruitment through peers (63.2%, 60/95) was more feasible than in clinics (36.8%, 35/90). Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1%) were male and African-American (76.8%), and 23.2% were Latino/Hispanic. Peer-recruited participants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct), and there were no differences in attitudes toward ART (e.g., mistrust), which were in the neutral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B = −10.4) and positively associated with self-efficacy (B = 5.5), positive outcome expectancies (B = 6.3), beliefs about personal necessity of ART (B = 17.5), and positive internal norms (B = 7.9). This study demonstrates the feasibility of engaging this vulnerable population through peer-referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared to those in hospital clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.

Population-Based Estimates of Life Expectancy After HIV Diagnosis

“…Hispanics/Latinos are more likely to enter care late and are more likely to discontinue treatment than whites 33,34 , which helps explain the higher AYLL among Hispanics/Latinos infected with HIV. Although life expectancy of blacks in the general population is slightly lower than that of whites, and blacks with diagnosed HIV have a higher rate of death than whites diagnosed with HIV, the life expectancy of the two groups was similar, with blacks showing a slightly longer life expectancy than whites in 2011.…”

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

“…Prisoners living with HIV are often people who inject drugs (PWID) who are incarcerated due to criminalization of drug use under Indonesian law. Although the structured prison setting offers opportunities to improve ART access and utilization [10–12], numerous individual and institutional factors may contribute to ART being delayed, declined, or discontinued in clinically eligible PLH, including a patient’s trust in physicians [13], belief in the personal necessity of ART [14], or readiness to commit to ART [15]. Prison overcrowding, opportunistic infections, and delayed ART initiation contribute to high HIV-related mortality in Indonesian prisons [16–18].…”

Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration

“…Thus participants were diverse with respect to socio-demographic, health, and other background characteristics, in keeping with the sampling approach. A description of the psychometric characteristics of structured measures used to assess the sample are described elsewhere [44]. …”

“…Procedures were approved by the Institutional Review Boards at New York University and two collaborating hospital sites. The larger study is described in more detail elsewhere [17, 44]. …”