Medication nonadherence, multitablet regimens, and food insecurity are key experiences in the pathway to incomplete HIV suppression

Almeida-Brasil, Celline Cardoso; Moodie, Erica E. M.; McLinden, Taylor; Hamelin, Anne-Marie; Walmsley, Sharon; Rourke, Sean B.; Wong, Alexander; Klein, Marina B.; Cox, Joseph

doi:10.1097/qad.0000000000001822

Cited by 13 publications

(13 citation statements)

References 37 publications

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“…Another more recent study showed higher (85.4%) adherence among those taking single-tablet first line regimens versus (82%) using multiple tablet regimens [31]. Though not much explored in these studies from Latin America, studies from other regions have highlighted the role of interpersonal factors, such as HIV stigma, social isolation, perceived discrimination [32], as well as structural factors, such as food insecurity, housing instability, ART regimen complexity [33], which likely play a role in the region as well and thus merit attention.…”

Section: Treatmentmentioning

confidence: 99%

The HIV epidemic in Latin America

Luz

Veloso

Grinsztejn

2019

Current Opinion in HIV and AIDS

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Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.

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Section: Treatmentmentioning

confidence: 99%

The HIV epidemic in Latin America

Luz

Veloso

Grinsztejn

2019

Current Opinion in HIV and AIDS

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“…While ART results in suppressed HIV replication in most cases, many patients fail to achieve persistent virological suppression [2]. Incomplete virological suppression is commonly due to irregular drug intake and/or antiretroviral drug resistance [3,4]. This compromises treatment outcomes for the individual, and also entails a risk of onward transmission, including dissemination of drugresistant strains [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

et al. 2020

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Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.

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“…Weiser et al [98] found that individuals who reported any food insecurity were 29% more likely to be virologically non-suppressed (aOR 1.29; 95% CI 1.04, 1.61); however, the same study [98] found no difference in virological suppression among food insecure individuals after adjusting for adherence. Six studies investigating food security and adherence found a significant negative adjusted association [42,56,64,65,67,98]. For instance, Almeida-Brasil et al [42] examined a cohort of adults in Canada living with HIV and hepatitis C and established that there was no difference in virological suppression (VL > 50 copies/mL) among individuals reporting income-related food insecurity (aOR 1.44; 95% CI 0.95, 2.19) but were more likely to be non-adherent to medication (aOR 1.77; 95% CI 1.26, 2.48).…”

Section: Food Securitymentioning

confidence: 99%

“…Six studies investigating food security and adherence found a significant negative adjusted association [42,56,64,65,67,98]. For instance, Almeida-Brasil et al [42] examined a cohort of adults in Canada living with HIV and hepatitis C and established that there was no difference in virological suppression (VL > 50 copies/mL) among individuals reporting income-related food insecurity (aOR 1.44; 95% CI 0.95, 2.19) but were more likely to be non-adherent to medication (aOR 1.77; 95% CI 1.26, 2.48).…”

Section: Food Securitymentioning

confidence: 99%

Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

et al. 2021

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Despite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

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Medication nonadherence, multitablet regimens, and food insecurity are key experiences in the pathway to incomplete HIV suppression

Abstract: Our results suggest that nonadherence, multitablet regimens, and food insecurity are key points in the pathway to incomplete HIV suppression. These are potentially amenable intervention targets that would not be revealed using traditional regression analyses.

Cited by 13 publications

References 37 publications

The HIV epidemic in Latin America

The HIV epidemic in Latin America

Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

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