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

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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.

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References

  1. Russian Federal AIDS Center. HIV infection: informational bulletin #30. [In Russian]. Moscow: Russian Federal AIDS Center; 2007. http://hivrussia.org/files/bul_30/00.pdf. Accessed 17 July 2016.

  2. Interfax. The number of HIV-positive persons in Russia officially has reached one million. [In Russian]. http://www.interfax.ru/russia/490634. Accessed 13 June 2016.

  3. Russian Federal AIDS Center. HIV infection: informational bulletin #40. [In Russian]. Moscow: Russian Federal AIDS Center; 2015. http://hivrussia.ru/files/bul_40.pdf. Accessed 13 June 2016.

  4. Pape U. Politics of HIV/AIDS in Russia. New York: Routledge; 2013.

    Google Scholar 

  5. Amirkhanian YA, Kelly JA, Kuznetsova AV, DiFranceisco WJ, Musatov VB, Pirogov DG. People living with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress. AIDS Behav. 2010;15:767–77.

    Article  Google Scholar 

  6. Amirkhanian YA, Kelly JA, McAuliffe TL. Psychosocial needs, mental health, and HIV transmission risk behavior among people living with HIV/AIDS in St. Petersburg, Russia. AIDS. 2003;17:2367–74.

    Article  PubMed  Google Scholar 

  7. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New Eng J Med. 2011;365:493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wood E, Kerr T, Marshall BP, et al. Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injection drug users: prospective cohort study. BMJ. 2009;338:b1649. doi:10.1136/bmj.b1649.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301:2380–2.

    Article  CAS  PubMed  Google Scholar 

  10. Granich RM, Gilks CF, Dye C, DeCock KM, Williams BG. HIV testing with immediate antiretroviral therapy as a strategy for the elimination of HIV transmission: a mathematical model. Lancet. 2009;373:48–57.

    Article  PubMed  Google Scholar 

  11. Montaner JSG. Treatment as prevention—a double hat-trick. Lancet. 2011;378:208–9.

    Article  PubMed  Google Scholar 

  12. Stover J, Hallett TB, Wu Z, et al. How can we get close to zero? The potential contribution of biomedical prevention and the investment framework towards an effective response to HIV. PLoS ONE. 2014;9(11):e111956.

    Article  PubMed  PubMed Central  Google Scholar 

  13. UNAIDS. Prevention gap report. Geneva: UNAIDS; 2016. http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf. Accessed 18 July 2016.

  14. Pokrovskaya A, Popova A, Ladnaya N, Yurin O. The cascade of HIV care in Russia, 2011–2013. J Int AIDS Soc. 2014;17(4 Suppl 3):19506.

    Article  PubMed  PubMed Central  Google Scholar 

  15. UNAIDS. Together we will end AIDS. Geneva: UNAIDS; 2012. http://www.unicef.org/aids/files/aids__togetherwewillendaids_en.pdf. Accessed 19 July 2016.

  16. Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52:793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP. Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav. 2011;15:1161–70.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bauman LJ, Braunstein S, Calderon Y, et al. Barriers and facilitators of linkage to HIV primary care in New York City. J Acquir Immune Defic Syndr. 2013;64(Suppl 1):S20–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mayer KH. Introduction: linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy. Clin Infect Dis. 2011;52(Suppl 2):S205–7.

    Article  PubMed  Google Scholar 

  20. Magnus M, Jones K, Phillips G, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr. 2010;53:529–36.

    Article  PubMed  Google Scholar 

  21. Haley DF, Lucas J, Golin CE, HPTN 064 Study Team, et al. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDS. 2014;28:206–17.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sprague C, Simon SE. Understanding HIV care delays in the US South and the role of the social-level in HIV care engagement/retention: a qualitative study. Int J Equity Health. 2014;13:28.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tedaldi EM, Richardson JT, Debes R, et al. Retention in care within 1 year of initial HIV care visit in a multisite US cohort: who’s in and who’s out? J Int Assoc Provid AIDS Care. 2014;13:232–41.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nunn A, Cornwall A, Fu J, Bazerman L, Loewenthal H, Beckwith C. Linking HIV-positive jail inmates to treatment, care, and social services after release: results from a qualitative assessment of the COMPASS program. J Urban Health. 2010;87:954–68.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials. 2009;10:299–305.

    Article  PubMed  Google Scholar 

  26. Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27:751–8.

    Article  PubMed  Google Scholar 

  27. Torian LV, Xia Q, Wiewel EW. Retention in care and viral suppression among persons living with HIV/AIDS in New York City, 2006–2010. Am J Public Health. 2014;104:e24–9. doi:10.2105/AJPH.2014.302080.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Grabmeier-Pfistershammer K, Rieger A, Schröck T, Schlag M. Economic burden of late presentation in HIV disease in Austria: a comparison of the initial costs imposed by advanced HIV disease versus non-late presentation. Wien Klin Wochenschr. 2013;125:402–7.

    Article  PubMed  Google Scholar 

  29. Fagan JL, Beer L, Garland P, et al. The influence of perceptions of HIV infection, care, and identity on care entry. AIDS Care. 2012;24:737–43.

    Article  PubMed  Google Scholar 

  30. St. Petersburg AIDS Center. HIV infection in St. Petersburg as of 1st of July, 2015: informational bulletin. St. Petersburg: St. Petersburg AIDS Center; 2015. http://www.hiv-spb.ru/assets/docs/ib/Informacionnyj%20bjulleten’%20CSPID%20za%206%20mesjacev%202015%20goda.pdf. Accessed 20 June 2016.

  31. Kalichman SC, Amaral CM, Swetzes C, Jones M, Macy R, et al. A simple single-item rating scale to measure medication adherence: further evidence for convergent validity. J Int Assoc Physicians AIDS Care. 2009;8:367–74.

    Article  Google Scholar 

  32. Balfour L, Tasca GA, Kowal J, et al. Development and validation of the HIV medication readiness scale. Assessment. 2007;14:408–16.

    Article  PubMed  Google Scholar 

  33. Erlen JA, Cha ES, Kim KH, Caruthers D, Sereika SM. The HIV medication taking self- efficacy scale: psychometric evaluation. J Adv Nurs. 2010;66:2560–72.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cutrona CE. Ratings of social support by adolescents and adult informants: degree of correspondence and prediction of depression symptoms. J Pers Soc Psychol. 1989;57:723–30.

    Article  CAS  PubMed  Google Scholar 

  35. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;43:861–5.

    Article  Google Scholar 

  36. Spielberger CD. State-trait anxiety inventory (form 4). Palo Alto: Consulting Psychologists Press; 1983.

    Google Scholar 

  37. Needle R, Fisher DG, Weatherby N, et al. Reliability of self-reported HIV risk behaviors of drug users. Psychol Addict Behav. 1995;9:242–50.

    Article  Google Scholar 

  38. IBM Corp. IBM SPSS statistics for windows, version 21.0. Armonk: IBM Corp.; 2012.

    Google Scholar 

  39. Gardner LI, Marks G, Shahani L, et al. Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use. AIDS. 2016;30:1111–9.

    Article  CAS  PubMed  Google Scholar 

  40. Pecoraro A, Royer-Malvestuto C, Rosenwasser B, et al. Factors contributing to dropping out from and returning to HIV treatment in an inner city primary care HIV clinic in the United States. AIDS Care. 2013;25:1399–406.

    Article  PubMed  Google Scholar 

  41. Williams EC, Bradley KA, Balderson BH, et al. Alcohol and associated characteristics among older persons living with human immunodeficiency virus on antiretroviral therapy. Subst Abuse. 2014;35:245–53.

    Article  Google Scholar 

  42. Wandera B, Tumwesigye NM, Nankabirwa JI, et al. Alcohol consumption among HIV-infected persons in a large urban HIV clinic in Kampala Uganda: a constellation of harmful behaviors. PLoS ONE. 2015;10:e0126236. doi:10.1371/journal.pone.0126236.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Cerutti B, Broers B, Masetsibi M, et al. Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study. BMC Public Health. 2016;16:947. doi:10.1186/s12889-016-3209-4.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kuznetsova AV, Meylakhs A, Amirkhanian YA, et al. Barriers and facilitators of HIV care engagement: results of a qualitative study in St. Petersburg, Russia. AIDS Behav. 2016;20(10):2433–43.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kelly JD, Hartman C, Graham J, Kallen MA, Giordano TP. Social support as a predictor of early diagnosis, retention, and adherence to HIV care: results from the Steps Study. J Assoc Nurses AIDS Care. 2014;25:405–13.

    Article  PubMed  PubMed Central  Google Scholar 

  46. McFadden RB, Bouris AM, Voisin DR, Glick NR, Schneider JA. Dynamic social support networks of younger Black men who have sex with men with new HIV infection. AIDS Care. 2014;26:1275–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Pecoraro A, Mimiaga MJ, O’Cleirigh C, et al. Lost-to-care and engaged-in-care HIV patients in Leningrad Oblast, Russian Federation: barriers and facilitators to medical visit retention. AIDS Care. 2014;26(10):1249–57.

    Article  PubMed  PubMed Central  Google Scholar 

  48. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015. http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1. Accessed 13 June 2016.

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Acknowledgements

This research was supported by Grants R01-MH098729, P30-MH52776, R21-MH102193 from the U.S. National Institute of Mental Health and by Grant 13-06-91440 from the Russian Foundation for Basic Research. The authors extend their appreciation to Timothy McAuliffe, Ruzanna Aleksanyan, Anastasia Meylakhs, Maria Donskaya, Dmitry Mescheryakov, Dmitry Pirogov, Rudolph Amirkhanian, Anastasia Amirkhanian, and Larissa Glyzhina.

Funding

This study was funded by the National Institute of Mental Health (Grant Numbers R01-MH098729 and P30-MH52776) and by the bilateral grant funded by the National Institute of Mental Health (Grant number R21-MH102193) and Russian Foundation for Basic Research (Grant Number 13-06-91440).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA

    Yuri A. Amirkhanian, Jeffrey A. Kelly, Wayne J. DiFranceisco & Sergey S. Tarima

  2. Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia

    Yuri A. Amirkhanian, Anna V. Kuznetsova, Alexey A. Yakovlev & Vladimir B. Musatov

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  1. Yuri A. Amirkhanian
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  2. Jeffrey A. Kelly
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  7. Vladimir B. Musatov
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Correspondence to Yuri A. Amirkhanian.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Amirkhanian, Y.A., Kelly, J.A., DiFranceisco, W.J. et al. Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia. AIDS Behav 22, 791–799 (2018). https://doi.org/10.1007/s10461-016-1638-9

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