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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Jardim BA, Jardim TA, França JC, Breda GL, Pavanelli GM, Pavanelli AM, Milano SS, Ribeiro CE, Raboni SM. Thirty-day readmission rates in a cohort of people living with HIV in southern Brazil, 2015 to 2017. Int J STD AIDS 2022; 33:433-441. [PMID: 35239420 DOI: 10.1177/09564624211047679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intense use of antiretroviral therapy (ART) has reduced morbidity and mortality of HIV infection. In Brazil, the specific contribution of diseases related to HIV infection leading to hospital admission and readmission is not well known. AIMS The study aimed to determine the clinico-epidemiological profile, 30-day readmission rate, and factors associated with this outcome in a cohort of adults with HIV infection in southern Brazil. METHODS Unicentric retrospective cohort, with data collection through the review of medical records and databases. RESULTS We analyzed 574 index hospitalizations and 451 individuals. Of these, 57.6% were men and the mean (±SD) age was 42.2 ± 12.3 years. Only 43.4% used ART regularly and low CD4 count and high frequency of detectable viral load were observed. HIV/AIDS-related diseases were identified in 55.2%, and tuberculosis was the most frequent etiology leading to index hospitalization. We found a 30-day readmission rate of 11.5% and hospitalization for HIV/AIDS-related illness was associated with a higher risk for the outcome. CONCLUSIONS These findings highlight the need to expand resources for prevention, early diagnosis, retention, and treatment of people living with HIV in the region to reduce HIV/AIDS-associated diseases and possibly minimize consequent hospital readmission of these individuals.
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Affiliation(s)
- Bruno A Jardim
- Program in Internal Medicine and Health Science, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Tyane Ap Jardim
- Program in Internal Medicine and Health Science, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
| | - João Cb França
- Infectious Diseases Division, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Giovanni L Breda
- Infectious Diseases Division, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Sibele S Milano
- Medical Course, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Clea El Ribeiro
- Curitiba Municipal Health Department, Curitiba, Paraná, Brazil
| | - Sonia M Raboni
- Infectious Diseases Division, 28122Federal University of Paraná, Curitiba, Paraná, Brazil
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Cruz Zonenschein AC, João Filho EC, Cruz MLS, Gouvea MI, Teixeira MDLB, Fuller T, Dias MAB. Treatment dropout after pregnancy: a study of women living with HIV in Rio de Janeiro. AIDS Care 2020; 32:1283-1289. [PMID: 32338056 DOI: 10.1080/09540121.2020.1755011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the investment in prevention of mother-to-child transmission of HIV, there is still little data about the proportion of women that are retained in treatment after pregnancy in Brazil. Research worldwide shows that a significant proportion of women drop out of treatment after pregnancy. The aim of this study was to identify factors associated with treatment dropout of women that received prenatal care at a federal hospital in Rio de Janeiro between 2016 and 2017 and abandoned treatment after pregnancy. This was a retrospective cohort study using data on prescription refills and hospital medical records. Cross-sectional analysis of data from 454 women showed that 18% were not on cART after pregnancy. Illicit drug use during pregnancy, being less than 35 years old, and being aware of HIV diagnosis before conceiving but not taking cART were factors associated with treatment interruption postpartum. The high prevalence of interruption of HIV treatment after pregnancy suggests that there is a need for better post-natal care to increase adherence in this population.
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Affiliation(s)
- Ana Clara Cruz Zonenschein
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Esaú Custódio João Filho
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Maria Isabel Gouvea
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Trevon Fuller
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA, USA
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Lin D, Zhang CY, He ZK, Zhao XD. How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies. BMC Public Health 2019; 19:789. [PMID: 31221113 PMCID: PMC6587270 DOI: 10.1186/s12889-019-7135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Socially disadvantaged groups, such as drug users, sex workers and homeless individuals, are labelled as "hard-to-reach" (HTR) in public health and medical research. HIV disproportionately impacts these populations, but data on how the HTR status could affect antiretroviral therapy (ART) adherence among HIV-positive people are limited and have not been previously synthesized in a systematic manner. We performed a meta-analysis to explore the association between HTR status and optimal antiretroviral therapy adherence in the HIV-infected population to provide evidence and recommendations regarding ART adherence improvement and HIV infection control and prevention among HTR people. METHODS The PubMed, EMBASE, and Cochrance Library databases and the bibliographies of relevant studies were systematically searched up to December 2018. Full-text studies published in English were included, and no geographic or race restrictions were applied. Studies that quantitatively assessed the association between HTR status and optimal ART adherence among HIV-infected populations with a status of homelessness, sex work, or drug use were eligible for inclusion. We estimated the pooled odds ratios (ORs) of HTR characteristics related to ART adherence from each eligible study using a random effects model. The sensitivity, heterogeneity and publication bias were assessed. RESULTS Our search identified 593 articles, of which 29 studies were eligible and included in this meta-analysis. The studies were carried out between 1993 and 2017 and reported between 1999 and 2018. The results showed that HTR status resulted in a 45% reduction in the odds of achieving optimal ART adherence compared to odds in the general population (OR = 0.55, 95% confidential intervals (CIs) 0.49-0.62), and this significant inverse association was consistently found regardless of study design, exposure measurement, adherence cut-off points, etc. Subgroup analyses revealed that the HTRs tend to be suboptimal adhering during a longer observational period. CONCLUSIONS HIV treatment adherence is extremely negatively affected by HTR status. It is crucial to develop appropriate interventions to improve ART adherence and health outcomes among HTR people who are HIV-infected.
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Affiliation(s)
- Dan Lin
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China.
| | - Chun-Yang Zhang
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
| | - Zi-Kai He
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
| | - Xiao-Dong Zhao
- Fujian Center for Disease Control and Prevention / Fujian Provincial Key Laboratory of Zoonosis Research, 76 Jintai Road, Fuzhou, China
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Costa JDM, Torres TS, Coelho LE, Luz PM. Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta-analysis. J Int AIDS Soc 2019; 21. [PMID: 29356390 PMCID: PMC5810329 DOI: 10.1002/jia2.25066] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Optimal 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. METHODS We 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 DISCUSSION The 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; I2 = 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. CONCLUSIONS Our 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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Affiliation(s)
- Jessica de Mattos Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Madhombiro M, Dube B, Dube M, Zunza M, Chibanda D, Rusakaniko S, Seedat S. Intervention for alcohol use disorders at an HIV care clinic in Harare: a pilot and feasibility study. Addict Sci Clin Pract 2019; 14:16. [PMID: 30953549 PMCID: PMC6451208 DOI: 10.1186/s13722-019-0143-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol use in HIV infected patients is associated with risky sexual behaviour, poor adherence to Highly Active Antiretroviral Therapy, treatment failure and increased physiologic harm. The objectives of the study were to pilot the outcome assessments to be used in the trial proper, assess the feasibility of delivery of a brief MI/CBT intervention compared to an WHO mhGAP intervention for problematic alcohol use in PLWH in Zimbabwe, and pilot the effectiveness (on alcohol use, functionality and CD4 count) of these interventions at 3 months in a randomised controlled trial design. METHODS An intervention for HIV infected patients with problematic alcohol use, developed through adaptation of existing evidence based psychological treatments, was assessed for its feasibility at a tertiary HIV care clinic in Zimbabwe. Registered general nurses, using a manualised protocol, delivered the intervention. Forty patients were recruited and randomised to receive either an MI/CBT intervention or the WHO mhGAP Intervention Guide for AUDs (n = 20 patients per group). RESULTS Out of 40 participants enrolled, 31 were successfully followed up for 3 months with a loss to follow-up rate of 23%. There was a statistically significant decrease in AUDIT score over time in both groups (p < 0.001), however no statistically significant group difference with a mean difference of 0.80, standard error of 2.07 and p = 0.70. For the CD4 count, the median and interquartile ranges at baseline for MI/CBT and WHO mhGAP IG groups were 218 (274) and 484 (211.50), respectively. At follow-up, median and interquartile ranges for the CD4 count for MI/CBT and WHO mhGAP IG groups were 390 (280) and 567 (378), respectively, indicative of improvement in immunological parameters in both arms. CONCLUSION The findings from this pilot study suggests that a brief MI/CBT delivered by Registered General Nurses for problematic alcohol use is feasible in this population but will require the implementation of additional measures to improve retention. However, mechanisms to improve retention need special attention. Trial registration Pan African Clinical Trial Registry, current PACTR201509001211149.
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Affiliation(s)
- Munyaradzi Madhombiro
- Department of Psychiatry, College of Health Sciences, Parirenyatwa Group of Hospitals, Avondale, Zimbabwe
- Psychiatric Hospital, Harare Central Hospital, Southerton, Zimbabwe
| | - Bazondlile Dube
- Department of Psychiatry, College of Health Sciences, Parirenyatwa Group of Hospitals, Avondale, Zimbabwe
| | - Michelle Dube
- Department of Psychiatry, College of Health Sciences, Parirenyatwa Group of Hospitals, Avondale, Zimbabwe
| | - Moleen Zunza
- Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, Parirenyatwa Group of Hospitals, Avondale, Zimbabwe
- Psychiatric Hospital, Harare Central Hospital, Southerton, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health sciences, Stellenbosch University, Cape Town, South Africa
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Santos MA, Guimarães MDC, Helena ETS, Basso CR, Vale FC, Carvalho WMDES, Alves AM, Rocha GM, Acurcio FDA, Ceccato MDGB, do Prado RR, Menezes PR, Nemes MIB. Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study. Medicine (Baltimore) 2018; 97:S38-S45. [PMID: 29912815 PMCID: PMC5991539 DOI: 10.1097/md.0000000000009015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient adherence to antiretroviral therapy (ART) is critical for HIV treatment success. Monitoring rates of adherence in public HIV outpatient care facilities can improve outcomes in Brazil where ART is universally available. METHODS We conducted a national cross-sectional survey of ART adherence in 2010. Participants were selected using a multistage probability sample. First, HIV outpatient care facilities were stratified according to 7 Organizational Quality Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected per region for each OQC group. Finally, patients were randomly selected at each facility. In a first component, patients were invited to answer to a web-based questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions on adherence to ART in the past 7 days (time scheduling-timing, drug regimen-medication, and pill counts-dose), herein named indicators of potential nonadherence (IPN). In addition, a subsample of participants were interviewed in order to obtain further data on sociodemographic and clinical characteristics (second component). The proportion of each IPN was estimated using weighted data to account for the sampling design with 95% confidence interval (CI) and descriptive analysis was carried out. RESULTS Fifty-five facilities were chosen and 2424 patients completed the WebAd-Q in the first component of the study, while 598 patients were interviewed for the second component. The weighted proportions of the IPN were 50.9%, 31.8%, and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3 indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5-63.7%). Patients reporting depression symptoms, illicit drug use and those who missed medical appointments had worse nonadherence outcomes. CONCLUSIONS Overall, there was a high proportion of all indicators IPN and timing was the main component associated with low adherence. Although these indicators may not necessarily indicate individual nonadherence, they represent a worrisome scenario in the public Brazilian HIV care facilities. On a routine basis, these facilities can identify gaps in providing counseling and ART orientation to their clientele and develop innovative strategies to prevent nonadherence.
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Affiliation(s)
- Maria Altenfelder Santos
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | - Cáritas Relva Basso
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | - Felipe Campos Vale
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | - Ana Maroso Alves
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | | | | | - Paulo Rossi Menezes
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
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Oliveira Serra MAA, Araújo E Silva R, Beserra EP, Melo TN, Sousa LV, Araújo MFM. Use of alcohol and drugs in the view of people living with HIV/AIDS: a qualitative study. Public Health 2017; 149:99-105. [PMID: 28582690 DOI: 10.1016/j.puhe.2017.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/25/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the meaning of the experiences of patients infected by HIV using antiretroviral therapy, regarding the use of alcohol and drugs. STUDY DESIGN A qualitative phenomenological study. METHOD A total of 25 patients receiving antiretroviral treatment participated in the investigation, of which 14 were male and 11 were females, who expressed their feelings and perceptions through participation in focus groups and the interpretation of costumes. The empirical material was transcribed in full and later organized and analyzed using the phenomenological method. RESULTS Based on this amusing experience we realized that participants were unaware of the effects of the use of alcohol and drugs in the AIDS progression. Since they have kept with their smoking and alcoholism habits to be accepted in a social group and consequently prevent prejudice. We believe that our health education strategy was adequate to improve antiretroviral therapy, since it helped in subject comprehension and patients self-care body expression. CONCLUSION This phenomenological study made it possible to understand the experience of patients living with HIV regarding the use of alcohol and drugs, and contributes to the planning and implementation of intervention programs based on a participative model of care, with a view to prioritizing the holistic aspects involved in the treatment of people living with HIV/AIDS.
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Affiliation(s)
| | | | - E P Beserra
- Federal University of Ceará, Fortaleza, Brazil
| | - T N Melo
- Federal University of Maranhão, Imperatriz, Brazil
| | - L V Sousa
- Federal University of Maranhão, Imperatriz, Brazil
| | - M F M Araújo
- University for International Integration Lusophony Afro Brazilian, Brazil
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Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America. J Pediatr 2017; 182:245-252.e1. [PMID: 28081884 PMCID: PMC5328796 DOI: 10.1016/j.jpeds.2016.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/13/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean. STUDY DESIGN This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy-naïve, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes in cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. RESULTS Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens. CONCLUSIONS Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas.
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Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America. AIDS Behav 2016; 20:2692-2699. [PMID: 27091028 DOI: 10.1007/s10461-016-1398-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This cross-sectional study describes substance use prevalence and its association with combination antiretroviral therapy (cART) adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3 % individuals reported having ≥1 alcoholic drinks, 5.0 % reported any illicit drug use and 17.0 % reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use [adjusted odds ratio (AOR) = 2.46, 95 % confidence interval (CI): 1.99-3.05], illicit drug use (AOR = 3.57, 95 % CI: 2.02-6.30), and using both alcohol and illicit drugs (AOR = 4.98, 95 % CI: 3.19-7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America.
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de Oliveira LCM, Dos Anjos MGT, Macedo Mustafé R, Sebastião Borges A. Alcohol consumption and associated factors among HIV/AIDS patients. Braz J Infect Dis 2016; 20:320-1. [PMID: 27054756 PMCID: PMC9425507 DOI: 10.1016/j.bjid.2016.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Rafael Macedo Mustafé
- Faculdade de Medicina, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Aércio Sebastião Borges
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
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Abstract
This study examined the difference in dog owning between Japan and the United States, and the effect of these differences on dogs' behavioral characteristics. Behavioral evaluations of privately-owned dogs were obtained by using online questionnaire. We compared background and demographic information from the two countries and analyzed the effects of these differences on behavioral characteristics in dogs. The results indicated that there was a bias in the dog breeds kept in Japan compared to the United States and that Japanese dogs' body weight was lower than the US dogs. The main source of dog acquisition was pet stores in Japan and breeders and/or shelters in the United States. Multiple linear regression analysis found that Japanese dogs showed more aggression to household members and higher energy, restlessness and fear of non-social stimuli than US dogs, while US dogs showed more fear of unfamiliar persons, separation-related behavior and excitability. US dogs also showed higher levels of trainability and attachment to owners. The lower dog's body weight was, the higher the behavioral scores except for trainability were. When dogs that were obtained under 3 months of age were analyzed, the younger the dogs were when their owners obtained them, the higher the scores on some behavioral problem factors were. The higher rates of problem behaviors among Japanese dogs compared with US dogs suggest that the preference for small breed dogs and poor early development environment influenced the behavioral characteristics of dogs.
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Ferro EG, Weikum D, Vagenas P, Copenhaver MM, Gonzales P, Peinado J, Cabello R, Lama JR, Sanchez J, Altice FL. Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru. AIDS Care 2014; 27:93-104. [PMID: 25277252 DOI: 10.1080/09540121.2014.963013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As international guidelines increase access to antiretroviral therapy (ART) globally, ART adherence becomes increasingly important to achieve HIV treatment as prevention (TasP) goals. In the concentrated HIV epidemic among men who have sex with men (MSM) and transgendered women (TGW) in Lima, Peru, the independent correlates of ART nonadherence were examined to inform treatment intervention priorities. Cross sectional survey of HIV-infected MSM and TGW who are engaged in clinical care in Lima, Peru. From June to August 2012, 302 HIV-infected Peruvian MSM/TGW from three clinical care sites were recruited using convenience sampling to participate in a cross-sectional computer-assisted adherence survey. Several standardized screening measures associated with ART nonadherence were examined in order to determine the independent correlates of optimal (≥90%) and perfect (100%) adherence, which were assessed using logistic regression. Of the 302 participants recruited, 263 (87.1%) were prescribed ART. Among those prescribed ART, 229 (87.1%) reported optimal and 146 (55.5%) reported perfect adherence. The prevalence of alcohol use disorders (AUD; 43.2%), alcohol dependence (5.3%), recent drug use (6.0%), and depression (44.5%) was high, and most participants had some evidence of neurocognitive impairment. Meeting criteria for having an AUD and depression were collinear (p < 0.001). On multivariate analysis, having an AUD was inversely related and the only independent correlate of optimal (AOR = 0.427; 95% CI = 0.187-0.976) and perfect (AOR = 0.552; 95% CI = 0.327-0.930) ART adherence. AUDs are highly prevalent among Peruvian HIV-infected MSM and contribute significantly to ART nonadherence. These findings support the need for screening and treating underlying AUDs. In order to meet HIV TasP goals, evidence-based strategies targeting AUDs are likely to directly improve ART adherence and indirectly improve overall individual health, HIV treatment engagement, and reduce transmission to sexual partners among this vulnerable and disproportionally affected population.
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Affiliation(s)
- Enrico G Ferro
- a Section of Infectious Diseases, AIDS Program , Yale School of Medicine , New Haven , CT , USA
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014; 12:142. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/preaccept-1453408941291432] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. METHODS We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. RESULTS In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. CONCLUSIONS These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
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Affiliation(s)
- Nienke Langebeek
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Elizabeth H Gisolf
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Peter Reiss
- />Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Sigrid C Vervoort
- />Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Thóra B Hafsteinsdóttir
- />Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Clemens Richter
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Mirjam AG Sprangers
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Pythia T Nieuwkerk
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/s12916-014-0142-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. Results In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, Netherlands.
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Factors associated with suboptimal adherence to antiretroviral therapy in Asia. J Int AIDS Soc 2014; 17:18911. [PMID: 24836775 PMCID: PMC4024656 DOI: 10.7448/ias.17.1.18911] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/26/2014] [Accepted: 04/07/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. METHODS As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients' adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) <100% and (ii) <95%. Follow-up time started from ART initiation and was censored at 24 months, loss to follow-up, death, treatment switch, or treatment cessation for >14 days. Time was divided into four intervals: 0-6, 6-12, 12-18 and 18-24 months. Factors associated with SubAdh were analysed using generalized estimating equations. RESULTS Out of 1316 patients, 32% ever reported <100% adherence and 17% ever reported <95%. Defining the outcome as SubAdh <100%, the rates of SubAdh for the four time intervals were 26%, 17%, 12% and 10%. Sites with an average of >2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. CONCLUSIONS We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social desirability bias could not be excluded, a greater emphasis on more frequent adherence counselling immediately following ART initiation and through the first six months may be valuable in promoting treatment and programme retention.
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Agudelo M, Khatavkar P, Yndart A, Yoo C, Rosenberg R, Devieux JG, Malow RM, Nair M. Alcohol abuse and HIV infection: role of DRD2. Curr HIV Res 2014; 12:234-42. [PMID: 25053368 PMCID: PMC4300295 DOI: 10.2174/1570162x12666140721115045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 04/25/2014] [Accepted: 04/28/2014] [Indexed: 11/22/2022]
Abstract
According to a survey from the HIV Cost and Services Utilization Study (HCSUS), approximately 53% of HIV-infected patients reported drinking alcohol and 8% were classified as heavy drinkers. The role of alcohol as a risk factor for HIV infection has been widely studied and recent research has found a significant association between heavy alcohol consumption and lower levels of CD4 T cells among HIV-infected alcoholics. Although there is evidence on the role of alcohol as a risk factor for HIV transmission and disease progression, there is a need for population studies to determine the genetic mechanisms that affect alcohol's role in HIV disease progression. One of the mechanisms of interest is the dopaminergic system. To date, the effects of dopamine on HIV neuroimmune pathogenesis are not well understood; however, dopaminergic neural degeneration due to HIV is known to occur by viral invasion into the brain via immune cells, and modulation of dopamine in the CNS may be a common mechanism by which different types of substances of abuse impact HIV disease progression. Although previous studies have shown an association of D(2) dopamine receptor (DRD2) polymorphisms with severity of alcohol dependence, the expression of this allele risk on HIV patients with alcohol dependence has not been systematically explored. In the current study, DRD2 Taq1A and C957T SNP genotyping analyses were performed in 165 HIV-infected alcohol abusers and the results were examined with immune status and CD4 counts.
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Affiliation(s)
| | | | | | | | | | | | | | - Madhavan Nair
- Department of Immunology, Institute of NeuroImmune Pharmacology, College of Medicine, AHC-I 308, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA.
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