Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia

Abstract

Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6 months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

“…Findings specifically support those of earlier studies that identified alcohol use as a risk factor for lower engagement in HIV care, 21–23,27,60 treatment with ART 24,25,27 and viral suppression. 26,27 Moreover, this study newly demonstrated a dose-dependent association between alcohol use and three HIV care continuum outcomes such that PLWH reporting alcohol use at medium, high, and very high levels had progressively lower likelihood of all care continuum outcomes relative to patients who reported non-drinking. Further, in secondary analyses, diagnosis for AUD was associated with lower likelihood of treatment with ART and viral suppression.…”

“…However, previous studies offer limited information on the influence of alcohol use on HIV care continuum targets in the U.S. for several reasons. First, most studies have been conducted within samples of PLWH living outside of the U.S. 17,24,25,27 or in recruited samples with limited generalizability. 18,30,31 Second, existing studies do not assess multiple components of the HIV care continuum in a single sample of PLWH, limiting understanding of the effect of alcohol use across care targets.…”

Global, regional and country-level 90–90–90 estimates for 2018

“…Despite this progress, it seems unlikely that many regions and countries will meet the 2020 target. knowledge of status in previously reported estimates was thought to be high as a result of extensive testing, but linkage to treatment remains a challenge [32,33]. In the Middle East and North Africa, persistently low estimates of knowledge of HIV status and treatment access point to the role of stigma and discrimination in service delivery as possible causes [34,35].…”

Monitoring the HIV continuum of care in key populations across Europe and Central Asia

“…Standard presentations of the HIV continuum of care at the national level are likely to mask variations that exist in and between key subpopulations. National descriptions of the continuum of care stratified by key populations have been undertaken in the USA , the UK , Belgium , Canada , Denmark , France , Georgia , Greece and Russia and international comparisons have been carried out . However, no baseline continuum of HIV care data are available for key populations for the whole European and Central Asian region.…”