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Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV

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Abstract

Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the “syndemic” model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69–1.47; 2 syndemic factors: 1.59, 0.89–2.84; 3 syndemic factors: 1.62, 0.44–5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.

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Data Availability

The datasets used and/or analyzed during the current study are available from the Penn State College of Medicine.

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Acknowledgements

The authors would like to thank Christine Quimby for her important contributions to data cleaning.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA

    Tarek B. Eshak

  2. Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA

    Andrea L. Hobkirk

  3. Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Cynthia J. Whitener

  4. Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA

    Liza M. Conyers

  5. Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA

    Wenke Hwang & Kristin K. Sznajder

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  1. Tarek B. Eshak
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  4. Liza M. Conyers
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Contributions

TBE conceived and designed the study, analyzed the data, and wrote the first draft of the manuscript. TBE, AH, CJW, LMC, WH, and KS, contributed to interpretation of data and read and approved the final manuscript.

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Correspondence to Tarek B. Eshak.

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Eshak, T.B., Hobkirk, A.L., Whitener, C.J. et al. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 28, 1612–1620 (2024). https://doi.org/10.1007/s10461-024-04275-5

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