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AIDS and Behavior

, Volume 20, Issue 11, pp 2692–2699 | Cite as

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

  • Raquel B. De BoniEmail author
  • Bryan E. Shepherd
  • Beatriz Grinsztejn
  • Carina Cesar
  • Claudia Cortés
  • Denis Padgett
  • Eduardo Gotuzzo
  • Pablo F. Belaunzarán-Zamudio
  • Peter F. Rebeiro
  • Stephany N. Duda
  • Catherine C. McGowan
Original Paper

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.

Keywords

Substance use Adherence HIV/AIDS Latin America 

Resumen

Este estudio transversal describe la prevalencia del uso de sustancias y su asociación con la adherencia a TARVc en 3433 individuos atendidos en centros clínicos de VIH en Argentina, Brasil, Chile, Honduras, México y Perú. Se aplicó una herramienta de escrutinio rápido para el uso de alcohol, marihuana, cocaína, heroína y metanfetaminas, así como para el reporte de dosis perdidas de TARV en los siete días anteriores. En general, 29.3 % participantes reportaron haber consumido una o más bebidas alcohólicas, 5% reportaron haber usado alguna droga ilícita y 17 % reportaron haber perdido al menos una dosis del TARVc. Usando un modelo de regresión logística, se observó que en comparación al grupo que no consumió ninguna sustancia, el uso de alcohol (odds ratio ajustada (AOR)=2.46, intervalo de confianza del 95 % (IC95 %): 1.99–3.05), el uso de cualquier sustancia ilícita (AOR=3.57, IC95%: 2.02–6.30), y el uso de ambos (AOR = 4.98, 95 % CI: 3.19–7.79) se asociaron a pierda de alguna dosis de TARVc. La relación entre el uso de sustancias y el incremento en la mala adherencia a la TARVc señala la necesidad de atender el uso de alcohol y drogas ilícitas para así mejorar la adherencia en personas que viven con VIH en América Latina.

Notes

Funding

This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA): U01 AI069923.

References

  1. 1.
    Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379(9810):55–70.CrossRefPubMedGoogle Scholar
  2. 2.
    Kipp AM, Desruisseau AJ, Qian HZ. Non-injection drug use and HIV disease progression in the era of combination antiretroviral therapy. J Subst Abuse Treat. 2011;40(4):386–96.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Meyer JP, Althoff AL, Altice FL. Optimizing care for HIV-Infected people who use drugs: evidence-based approaches to overcoming healthcare disparities. Clin Infect Dis. 2013;57(9):1309–17.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McGowan CC, Weinstein DD, Samenow CP, Stinnette SE, Barkanic G, Rebeiro PF, et al. Drug use and receipt of highly active antiretroviral therapy among HIV-infected persons in two U.S. clinic cohorts. PLoS One. 2011;6(4):1–8.CrossRefGoogle Scholar
  5. 5.
    Cohn SE, Jiang H, McCutchan JA, Koletar SL, Murphy RL, Robertson KR, et al. Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362. AIDS Care. 2011;23(6):775–85.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lucas GM. Substance abuse, adherence with antiretroviral therapy, and clinical outcomes among HIV-infected individuals. Life Sci. 2011;88(21–22):948–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Arnsten JH, Demas PA, Farzadegan H, Grant RW, Gourevitch N, Chang C, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-reported and electronic monitoring. Clin Infect Dis. 2001;33(8):1417–23.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP, and 2007 Reference Group to the UN on HIV and Injecting Drug Use. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45.CrossRefPubMedGoogle Scholar
  9. 9.
    Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems Cohort. Am J Public Health. 2013;103(8):1457–67.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wakefield JC, Schmitz MF. The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. Addiction. 2015;110:931–42.CrossRefPubMedGoogle Scholar
  11. 11.
    Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112(3):178–93.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chibanda D, Benjamin L, Weiss HA, Abas M. Mental, neurological, and substance use disorders in people living with HIV/AIDS in low- and middle-income countries. J Acquir Immune Defic Syndr. 2014;67:s54–67.CrossRefPubMedGoogle Scholar
  13. 13.
    Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223–34.CrossRefPubMedGoogle Scholar
  14. 14.
    Malta M, Magnanini M, Strathdee SA, Bastos FI. Adherence to antiretroviral therapy among HIV-Infected drug users: a meta-analysis. AIDS Behav. 2010;14:731–47.CrossRefPubMedGoogle Scholar
  15. 15.
    UNODC. World Drug Report. Vienna: United Nations; 2013.Google Scholar
  16. 16.
    Teixeira C, Dourado MDL, Santos MP, Brites C. Impact of use of alcohol and illicit drugs by AIDS patients on adherence to antiretroviral therapy in Bahia, Brazil. AIDS Res Hum Retroviruses. 2013;29:799–804.CrossRefPubMedGoogle Scholar
  17. 17.
    Ferro E, Weikum D, Vagenas P, Copenhaver M, Gonzales P, Peinado J, et al. Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru. AIDS Care. 2015;27(1):93–104.CrossRefPubMedGoogle Scholar
  18. 18.
    Mcgowan CC, Cahn P, Gotuzzo E, Padgett D, Pape JW, Wolff M, et al. Cohort profile: Caribbean, Central and South America Network for HIV research (CCASAnet) collaboration within the International Epidemiologic Databases to Evaluate AIDS (IeDEA) programme. Int J Epidemiol. 2007;36:969–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Rasbach DA, Desruisseau AJ, Kipp AM, Stinnette S, Kheshti A, Shepherd BE, et al. Active cocaine use is associated with lack of HIV-1 virologic suppression independent of nonadherence to antiretroviral therapy: use of a rapid screening tool during routine clinic visits. AIDS Care. 2013;25(1):109–17.CrossRefPubMedGoogle Scholar
  20. 20.
    Teixeira C, Dourado MDL, Santos MP, Brites C. Impact of use of alcohol and illicit drugs by AIDS patients on adherence to antiretroviral therapy in Bahia, Brazil. AIDS Res Hum Retroviruses. 2013;29(5):799–804. http://www.ncbi.nlm.nih.gov/pubmed/23294471.
  21. 21.
    Macdonald S, Pakula B, Martin G, Wells S, Borges G, Roth E, et al. Health profiles of clients in substance abuse treatment: a comparison of clients dependent on alcohol or cocaine with those concurrently dependent. Subst Use Misuse. 2014;49(14):1899–907.CrossRefPubMedGoogle Scholar
  22. 22.
    Cofrancesco J, Scherzer R, Tien P, Gibert C, Southwell H, Sidney S, et al. Illicit drug use and HIV treatment outcomes in a US cohort. AIDS. 2008;22(3):357–65.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bastos FI. Crack in Brazil: a public health emergency. Cad Saude Publica. 2012;28(6):1016–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Inciardi JA, Surratt HL, Pechansky F, Kessler F, von Diemen L, da Silva EM, et al. Changing patterns of cocaine use and HIV risks in the south of Brazil. J Psychoactive Drugs. 2006;38(3):305–10. http://www.ncbi.nlm.nih.gov/pubmed/17165373.
  25. 25.
    Abdalla RR, Madruga CS, Ribeiro M, Pinsky I, Caetano R, Laranjeira R. Prevalence of cocaine use in Brazil: data from the II Brazilian National Alcohol and Drugs Survey (BNADS). Addict Behav. 2014;39(1):297–301.CrossRefPubMedGoogle Scholar
  26. 26.
    SantosCruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, et al. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. Int J Drug Policy. 2013;24(5):432–8.CrossRefGoogle Scholar
  27. 27.
    Edlin R, Irwin K, Faruque S, McCoy C, Word C, Serrano Y, et al. Intersecting epidemics—crack cocaine use and HIV infection among inner-city young adults. N Engl J Med. 1994;331(21):1422–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Bell C, Metsch L, Vogenthaler N, Cardenas G, Rodriguez A, Locascio V, et al. Never in care: characteristics of HIV-infected crack cocaine users in two US cities who never been to outpatient HIV care. J Acquir Immune Defic Syndr. 2010;54(4):376–80.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Metsch LR, Pereyra M, Brewer TH. Use of HIV health care in HIV-seropositive crack cocaine smokers and other active drug users. J Subst Abuse. 2001;13(1–2):155–67.CrossRefPubMedGoogle Scholar
  30. 30.
    Rentsch C, Tate JP, Akgün KM, Crystal S, Wang KH, Ryan Greysen S, et al. Alcohol-related diagnoses and all-cause hospitalization among HIV-infected and uninfected patients: a longitudinal analysis of United States Veterans from 1997 to 2011. AIDS Behav. 2015. doi:10.1007/s10461-015-1025-y.Google Scholar
  31. 31.
    Elliott JC, Aharonovich E, O’Leary A, Johnston B, Hasin DS. Perceived medical risks of drinking, alcohol consumption, and hepatitis C status among heavily drinking HIV primary care patients. Alcohol Clin Exp Res. 2014;38(12):3052–9.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Mitchell AJ, Meader N, Bird V, Rizzo M. Clinical recognition and recording of alcohol disorders by clinicians in primary and secondary care: meta-analysis. Br J Psychiatry. 2012;201:93–100.CrossRefPubMedGoogle Scholar
  33. 33.
    Lima V, Harrigan R, Bangsberg D, Hogg R, Gross R, Yip B, et al. The combined effect of modern Highly Active Antiretroviral Therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009;50(5):529–36.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.CrossRefPubMedGoogle Scholar
  35. 35.
    Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011;15(7):1381–96.CrossRefPubMedGoogle Scholar
  36. 36.
    Hugen PWH, Langebeek N, Burger DM, Zomer B, van Leusen R, Schuurman R, et al. Assessment of adherence to HIV protease inhibitors: comparison and combination of various methods, including MEMS (electronic monitoring), patient and nurse report, and therapeutic drug monitoring. J Acquir Immune Defic Syndr. 2002;30(3):324–34.CrossRefPubMedGoogle Scholar
  37. 37.
    Binford MC, Kahana SY, Altice FL. A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs. Curr HIV/AIDS Rep. 2012;9(4):287–312. http://www.ncbi.nlm.nih.gov/pubmed/22936463. Cited 2013.
  38. 38.
    Barclay TR, Hinkin CH, Castellon SA, Mason KI, Reinhard MJ, Marion SD. Age-associated predictors of medication adherence in HIV-positive adults : health beliefs, self-efficacy, and neurocognitive status. Heal Psychol. 2010;26(1):40–9.CrossRefGoogle Scholar
  39. 39.
    Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18(Suppl 1):S19–25.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ghidei L, Simone M, Salow M, Zimmerman K, Paquin A, Skarf M, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging. 2013;30(10):997–1003.CrossRefGoogle Scholar
  41. 41.
    Yehia BR, Rebeiro P, Althoff KN, Agwu AL, Horberg MA, Samji H, et al. Impact of age on retention in care and viral suppression. J AIDS. 2015;68(4):413–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Raquel B. De Boni
    • 1
    Email author
  • Bryan E. Shepherd
    • 2
  • Beatriz Grinsztejn
    • 1
  • Carina Cesar
    • 3
  • Claudia Cortés
    • 4
  • Denis Padgett
    • 6
  • Eduardo Gotuzzo
    • 5
  • Pablo F. Belaunzarán-Zamudio
    • 7
  • Peter F. Rebeiro
    • 2
  • Stephany N. Duda
    • 2
  • Catherine C. McGowan
    • 2
  1. 1.Instituto Nacional de Infectologia Evandro Chagas - FIOCRUZRio de JaneiroBrazil
  2. 2.Vanderbilt UniversityNashvilleUSA
  3. 3.Fundación HuéspedBuenos AiresArgentina
  4. 4.Fundación ArriaranSantiagoChile
  5. 5.Instituto Hondureno de Seguridad Social and Hospital EscuelaTegucigalpaHonduras
  6. 6.Universidad Peruana Cayetano HerediaLimaPeru
  7. 7.Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico

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