Sticking to It: The Effect of Maximally Assisted Therapy on Antiretroviral Treatment Adherence Among Individuals Living with HIV Who are Unstably Housed

Abstract

Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72–13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.

Emergency Department Use among HIV-Infected Released Jail Detainees

“…62,63 Additionally, and importantly for this particular cohort in which housing status was defined by "anticipated" housing status after release, homelessness is a concern upon release because many individuals lose their housing during incarceration. 63 Homelessness, specifically among PLWHA, is associated with a greater reliance on the ED for health needs, 30,64 having more advanced HIV, 65 and mortality. 18 A recent study of PLWHA released from jail confirmed homelessness as being associated with SUDs, comorbid psychiatric conditions, lacking an HIV provider, and suboptimal ART adherence.…”

Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review

“…Twelve studies [13,37,38,[40][41][42][43][45][46][47][48][49] were cross-sectional, five were prospective cohort studies [15,16,[50][51][52], one was a retrospective cohort [53], and one was a case-control study [54]. One cross-sectional study [37] analyzed ART adherence as the exposure and food insecurity as the outcome (the inverse of the pathway of interest); this study is included but cannot be directly compared to the other studies that examined food insecurity as the exposure of interest.…”

“…Only three studies [13,15,16] used complete, validated food security scales to measure food insecurity whereas six studies [37,40,41,46,47,53] used modified versions of validated food insecurity scales (i.e. the US Food Security Scale and the Radimer/Cornell Questionnaire) and two studies [50,54] assessed food access with multiple questions that were not from validated scales ( Table 2).…”

“…''food insufficiency,'' ''hunger'') to refer to similar constructs. Measurement of ART adherence also varied; twelve studies used participant self-report, three [47,50,53] used pharmacy records, and four studies [13,40,41,46] used unannounced pill counts to compute the ratio of pills counted relative to pills prescribed. The selfreport assessments ranged from one to multiple questions or assessment by a visual analog scale and also had various recall periods.…”

“…Thirteen studies presenting the relationship between food insecurity and ART adherence adjusted for covariates, while six studies [13,37,43,47,49,53] only presented an unadjusted measure of association. Studies adjusted for different sets of covariates, and most studies controlled for common confounders such as substance abuse, depression, and comorbidities.…”