Substance Use, Violence, and Antiretroviral Adherence: A Latent Class Analysis of Women Living with HIV in Canada

Carter, Allison; Roth, Eric Abella; Ding, Erin; Milloy, M‐J; Kestler, Mary; Jabbari, Shahab; Webster, Kath; Pokomandy, Alexandra de; Loutfy, Mona; Kaida, Angela

doi:10.1007/s10461-017-1863-x

Cited by 34 publications

(26 citation statements)

References 77 publications

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“…Latent class analysis (LCA) is a statistical methodology that permits detection of groups (latent classes) that cannot be directly observed on the basis of categorical indicator variables alone [ 11 , 12 ]. This methodology has been increasingly used in the behavioral sciences to detect otherwise unobservable at-risk subgroups within a population based on patterns of individual risk-associated behaviors [ 13 , 14 ]. For example, LCA was used to better define substance abuse patterns among women living with HIV and to associate those patterns with likelihood of antiretroviral adherence [ 13 ] The use of computational methods like LCA to deconstruct complex patient decision-making associated with care disengagement may enrich our ability to detect patients at highest risk of falling out of HIV care and subsequently help target retention interventions to appropriate individuals.…”

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confidence: 99%

“…This methodology has been increasingly used in the behavioral sciences to detect otherwise unobservable at-risk subgroups within a population based on patterns of individual risk-associated behaviors [ 13 , 14 ]. For example, LCA was used to better define substance abuse patterns among women living with HIV and to associate those patterns with likelihood of antiretroviral adherence [ 13 ] The use of computational methods like LCA to deconstruct complex patient decision-making associated with care disengagement may enrich our ability to detect patients at highest risk of falling out of HIV care and subsequently help target retention interventions to appropriate individuals. We evaluate the use of health care engagement behaviors (emergency department utilization and inpatient admission) to empirically understand patterns of HIV care engagement and to identify groups of individuals at highest risk for disengagement from HIV care.…”

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confidence: 99%

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Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis

Okeke

Clement

McKellar

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons living with HIV (PLWH) interact with the health care system.MethodsWe conducted a retrospective analysis of patients with ≥1 HIV clinic visits at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Health care utilization was characterized by 4 indicators: clinic attendance in each half of the year (yes/no), number of emergency department (ED) visits/year (0, 1, or 2+), inpatient admissions/year (0, 1, 2+), and viral suppression (never, intermittent, always). Health care engagement patterns were modeled using latent class/latent transition analysis.Results. A total of 2288 patients (median age, 46.4 years; 59% black, 71% male) were included in the analysis. Three care engagement classes were derived from the latent class model: “adherent” “nonadherent,” and “sick.” Patients age ≤40 years were more likely to be in the nonadherent class (odds ratio, 2.64; 95% confidence interval, 1.38–5.04) than other cohort members. Whites and males were more likely to transition from nonadherent to adherent the following year. Nonadherent patients were significantly more likely to disengage from care the subsequent year than adherent patients (23.6 vs 0.2%, P < .001).ConclusionsA broader definition of health care engagement revealed distinct and dynamic patterns among PLWH that would have been hidden had only previous HIV clinic attendance had been considered. These patterns may be useful for designing engagement-targeted interventions.

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confidence: 99%

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confidence: 99%

Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis

Okeke

Clement

McKellar

et al. 2018

Open Forum Infectious Diseases

View full text Add to dashboard Cite

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“…Additionally, methadone, home‐made opioids and amphetamines were the predominant injected substances. The extensive use of varying types of substances, may delay engagement and hinder benefits of HIV and substance use treatment among PWID .…”

Section: Discussionmentioning

confidence: 99%

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

et al. 2018

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IntroductionPeople who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention.MethodsWe present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two‐arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV‐positive index and their HIV‐negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours.ResultsThe majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self‐reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test – Alcohol Consumption Questions (AUDIT‐C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions.ConclusionsWhile regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

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“…An additional variable was created to designate abstinence from use of all drugs, including before or during sex. Inclusion of an abstinent group has been found to be of value in other research of drug-using women (34). All variables were coded dichotomously for use in PROC LCA (ever/never past month) such that any non-zero number of days in the past month was coded to ever (35).…”

Section: Methodsmentioning

confidence: 99%

A latent class analysis of alcohol and drug use immediately before or during sex among women

Reynolds

Fisher

2018

The American Journal of Drug and Alcohol Abuse

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Background: Alcohol and drug use by women is related to high-risk sexual practices and protective behaviors. Objectives: To determine sexual risk and protective behaviors using information about women’s drug use immediately before or during sex. Methods: Latent class analysis using PROC LCA in SAS software was used to determine classes of women using both past 30-day drug use and before or during sex. Participants were recruited from a community-based research site located in a low socio-economic area of Los Angeles County and completed the Risk Behavior Assessment which elicits information on drug and sex risk behaviors. Results: The Risk Behavior Assessment, and HIV and sexually transmitted infections testing was obtained on 812 women. Five distinct groups were identified by PROC LCA: An Abstinent group comprised of 26% of participants; an Alcohol and Marijuana group (16%); an Amphetamine group (11%); a No Sex-with-Alcohol group (37%); and a Poly Drug group (11%). Multinomial logistic regression revealed that sexual behaviors and condom use were different across the five groups: The Alcohol and Marijuana group had a higher odds of vaginal intercourse, while the No Sex-with-Alcohol group was most likely to use condoms for vaginal intercourse. The Poly Drug group had the highest risk for anal intercourse while the Amphetamine and Poly Drug groups had high proportions of women with injection-drug using and men-who-have-sex-with-men sexual partners. Conclusion: Identifying women based on drug use immediately before or during sex can help providers understand prevention and risk-reduction practices and interventions for drug-using women.

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Substance Use, Violence, and Antiretroviral Adherence: A Latent Class Analysis of Women Living with HIV in Canada

Cited by 34 publications

References 77 publications

Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis

Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

A latent class analysis of alcohol and drug use immediately before or during sex among women

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