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Antiretroviral Drug Diversion Links Social Vulnerability to Poor Medication Adherence in Substance Abusing Populations

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Abstract

Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg–Andersen behavioral model of health care utilization for vulnerable populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n = 503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25 % of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient–provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

Resumen

El desvío de los medicamentos antiretrovirales (ARV) al mercado ilícito ha sido documentado en el sur de la Florida, y vinculado a la adherencia subóptima al tratamiento ARV de las personas viviendo con VIH. El desvío de ARVs refleja una necesidad insatisfecha de la atención del VIH entre poblaciones vulnerables que muestran dificultades en el cuidado consistente del VIH debido a otras necesidades competentes y las comorbilidades asociadas al VIH. Este estudio aplica el modelo de comportamiento y utilización de servicios entre poblaciones vulnerables de Gelberg-Andersen para entender como las vulnerabilidades sociales se vincula al desvío de los medicamentos ARV y a la adherencia a los ARV. Los datos transversales se obtuvieron de una muestra seleccionada de personas vulnerables viviendo con VIH en el sur de la Florida entre 2010 y 2012 (n = 503). Por medio de entrevistas estructuras se recolectaron datos cuantitativos sobre el desvío de los ARV, el acceso y la utilización de servicios de salud, y la adherencia a los ARV. Utilizamos regresión logística para estimar la bondad de ajuste de modelos aditivos que se ponen a la prueba cada dominio. Se utilizó regresión lineal para estimar los efectos de la vulnerabilidad social y el desvío de ARV sobre la adherencia a los ARV. El mejor modelo para predecir el desvío de ARV identificó que los factores que promueven el desvío de ARV fueron un bajo ingreso mensual y un inestable fuente de cuidado del VIH. Es importante notar que los factores de necesidad de salud no fueron factores protectores contra el desvío de los ARV, prueba que en esta muestra las necesidades inmediatas son priorizadas incluso enfrentando un mal estado de salud. También encontramos que el desvío de los ARV proporciona un vínculo entre la vulnerabilidad social y la adherencia subóptima de los ARV, con el desvío de los ARV y los dominios del modelo de comportamiento explicando el 25 % de la variación en la adherencia a los ARV. Nuestros análisis revelan una gran necesidad de mejorar la participación en la atención del VIH entre las poblaciones vulnerables mediante el fortalecimiento de los factores “enabling” (por ejemplo, la relación pacienteproveedor) para mejorar la retención en la atención del VIH y la adherencia a los ARV entre las poblaciones vulnerables.

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Acknowledgments

This research is supported by PHS Grant Number R01DA023157 from the National Institute on Drug Abuse. NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of this report; or in the decision to submit the paper for publication. This research was also supported by the Training Program in Substance Use, HIV, and Related Infections (NIDA T32 DA 023356).

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  1. Division of Global Public Health, School of Medicine, University of California, San Diego (UCSD), 9500 Gilman Drive 0507, La Jolla, CA, 92093-0507, USA

    Kiyomi Tsuyuki

  2. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA

    Hilary L. Surratt

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Tsuyuki, K., Surratt, H.L. Antiretroviral Drug Diversion Links Social Vulnerability to Poor Medication Adherence in Substance Abusing Populations. AIDS Behav 19, 869–881 (2015). https://doi.org/10.1007/s10461-014-0969-7

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