Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

Boni, Raquel Brandini De; Shepherd, Bryan E.; Grinsztejn, Beatriz; César, Carina; Cortés, Claudia; Padgett, Denis; Gotuzzo, Eduardo; Belaunzarán-Zamudio, Pablo F.; Rebeiro, Peter F; Duda, Stephany N.; McGowan, Catherine C.

doi:10.1007/s10461-016-1398-6

Cited by 32 publications

(32 citation statements)

References 40 publications

(45 reference statements)

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“…The prevalence of 90-day alcohol use (30.1%), marijuana use (3.9%), and crack/cocaine use (3.1%) was similar to a one-week prevalence found in the same cohort, 34 although 90-day tobacco use (19.5%) was smaller than that of 12-month use (29%), 33 as expected. All estimates, however, were lower than that of U.S. HIV-infected cohorts, where 50–70% report smoking, 35 53% report drinking in the past month, 36 and 24 and 9% report 90-day marijuana and crack/cocaine use, respectively.…”

Section: Discussionsupporting

confidence: 80%

Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study

et al. 2017

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Self-rated health (SRH) is associated with morbidity and mortality in HIV-uninfected populations but is understudied in HIV. Substance use may affect SRH in addition to its deleterious effect on HIV disease. This analysis aimed to estimate SRH and substance use prevalence and evaluate factors associated with poor SRH among individuals in HIV care in Rio de Janeiro, Brazil. A convenience sample of HIV-infected adults completed one item of SRH, the Alcohol, Smoking and Substance Involvement Screening Test, and the Patient Health Questionnaire-2 (PHQ-2). Logistic regression models identified factors associated with poor SRH. Participants’ (n = 1029) median age was 42.9 years, 64.2% were male, and 54.5% were nonwhite. Poor SRH was reported by 19.5% and the use of alcohol, tobacco, marijuana, and crack/cocaine by 30.1, 19.5, 3.9, and 3.5%, respectively. Less than high school education (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI]: 1.08–2.20), lack of sexual activity in previous 12 months (aOR 1.53, 95% CI: 1.01–2.30), crack/cocaine use (aOR 3.82, 95% CI: 1.80–8.09), positive PHQ-2 screen (aOR 3.43, 95% CI: 2.09–5.62), and HIV-1 RNA ≥40 c/ml (aOR 2.51, 95% CI: 1.57–4.02) were significantly associated with poor SRH as identified by logistic regression analyses. Alcohol, marijuana, and sedative use were not significantly associated with poor SRH. These results emphasize the need for substance use and mental health screening and treatment in this population. Further research may elucidate the consequences of poor SRH on treatment adherence, morbidity, and mortality in HIV-infected individuals.

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Section: Discussionsupporting

confidence: 80%

Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study

et al. 2017

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“…The flow diagram of study selection is shown in Figure . Fifty‐three studies, composed of 22,603 participants in ART from 25 LAC countries, met eligibility criteria for the systematic review (Table ) . The median number of participants in ART per study was 201 [range: 13 – 3343; interquartile range (IQR): 394 – 125].…”

Section: Resultsmentioning

confidence: 99%

Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta‐analysis

et al. 2018

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IntroductionOptimal adherence to antiretroviral therapy is closely related with suppression of the HIV viral load in plasma, slowing disease progression and decreasing HIV transmission rates. Despite its importance, the estimated proportion of people living with HIV in Latin America and the Caribbean with optimal adherence has not yet been reported in a meta‐analysis. Moreover, little is known of the factors leading to poor adherence which may be setting‐specific. We present a pooled estimate of adherence to antiretroviral therapy (ART) of people living with HIV in Latin America and Caribbean, report the methods used to measure adherence and describe the factors associated with poor adherence among the selected studies.MethodsWe electronically searched published studies up to July 2016 on the PubMed, Web of Science and Virtual Health Library (Latin America and the Caribbean Regional Portal); considering the following databases: MEDLINE, LILACS, PAHO and IBECS. Two independent reviewers selected and extracted data on ART adherence and study characteristics. Pooled estimate of adherence was derived using a random‐effects model. Risk of bias in individual studies was assessed independently by two investigators using the Risk of Bias Assessment tool for Non‐randomized Studies (RoBANS).Results and discussionThe meta‐analysis included 53 studies published between 2005 and 2016, which analysed 22,603 people living with HIV in 25 Latin America and Caribbean countries. Overall adherence in Latin America and Caribbean was 70% (95% CI: 63–76; I 2 = 98%), similar to levels identified by studies conducted in high‐income regions. Self‐report was the most frequently used method to measure adherence. Subgroup analysis showed that adherence was higher for the shortest recall time frame used, as well as in countries with lower income level, Gross National Income (GNI) per capita and Human Development Index (HDI). Studies reported diverse adherence barriers, such as alcohol and substance misuse, depression, unemployment and pill burden.ConclusionsOur study suggests that adherence to ART in Latin America and Caribbean may be below the sufficient levels required for a successful long‐term viral load suppression.

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“…In an analysis of the same cohort, periods of active injection drug use were associated with transitions out of optimal adherence and as barriers to becoming optimally adherent [20]. Another study conducted among 3,343 PLHIV in care across six countries from Latin America in 2012–2013 found that between 29% and 46% of people who used alcohol or illicit drugs reported missing ART doses in the prior week, compared to only 11% of individuals who did not report substance use [17]. …”

Section: Recent Trends In Art Adherence Among Pwudmentioning

confidence: 99%

“…A recent review examining the impacts of alcohol on the HIV cascade of care continuum published between 2010 and 2015 found an association between alcohol use and nonadherence, usually in a dose-response fashion, in most (n=16) of the 33 included studies focusing on the ART adherence step [22]. Other recent studies confirm this negative influence of alcohol on ART adherence in a variety of contexts [23, 17, 24, 25]. …”

Section: Specific Substances and Art Adherencementioning

confidence: 99%

Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

Socías

Milloy

2018

Curr Infect Dis Rep

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Studies continue to demonstrate the negative impacts of substance use and related disorders on antiretroviral therapy adherence, with the exception of cannabis. Evidence-based addiction treatment, in particular, opioid agonist therapy, appears to improve adherence levels. Most individual-level adherence specific interventions did not provide sustained effects, and no studies evaluating structural-level interventions were found. Findings suggest the urgent need to scale-up opioid agonist therapy, as well as to simultaneously address multiple structural barriers to care to optimize HIV treatment outcomes among people who use drugs.

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Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

Cited by 32 publications

References 40 publications

Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study

Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study

Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta‐analysis

Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

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