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Prevalence and Correlates of Reporting Difficulty Taking Antiretroviral Treatment Among HIV-Positive Illicit Drug Users in Vancouver, Canada: A Longitudinal Analysis

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Abstract

People living with HIV who use illicit drugs continue to experience high rates of suboptimal treatment outcomes from antiretroviral therapy (ART). Although previous studies have identified important behavioural, social and structural barriers to ART adherence, the effects of patient-level factors have not been fully evaluated. Thus, we sought to investigate the prevalence and correlates of reporting ART was difficult to take among a cohort of illicit drug users in Vancouver, Canada. We accessed data from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), an ongoing prospective cohort of HIV-positive illicit drug users linked to comprehensive HIV clinical monitoring records. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods in which individuals reported they found ART difficult to take. Between December 2005 and May 2014, 746 ART-exposed illicit drug users were recruited and contributed at least one study interview. Finding ART hard to take was reported by 209 (28.0%) participants at baseline, and 460 (61.7%) participants throughout the study period. Patients ingesting a greater daily pill count (adjusted odds ratio [AOR] = 1.12 per pill, 95% confidence interval [CI] 1.08–1.17) and experiencing barriers to healthcare (AOR = 1.64, 95% CI 1.34–2.01) were more likely to report difficulty taking ART. Patients less likely to report satisfaction with their HIV physician (AOR = 0.76, 95% CI 0.58–1.00) and achieve a non-detectable HIV viral load (AOR = 0.62, 95% CI 0.51–0.74) were more likely to report finding ART hard to take. In this community-recruited cohort of ART-exposed illicit drug users, a substantial proportion reported they found HIV treatment hard to take, which was clearly linked to higher dissatisfaction with healthcare experiences and, most importantly, a lower likelihood of experiencing optimal virologic outcomes. Our findings reveal a number of opportunities to improve HIV treatment experiences and outcomes for people who use illicit drugs, including the use of treatment regimens with lower pill burdens, as well as reducing barriers to healthcare access.

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References

  1. The HIV-CAUSAL Collaboration. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010;24:123–37.

    Article  PubMed Central  Google Scholar 

  2. Palella FJ, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.

    Article  CAS  Google Scholar 

  3. Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338:853–60.

    Article  PubMed  Google Scholar 

  4. Blashill AJ, Bedoya A, Mayer KH, et al. Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS Behav. 2015;19:981–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA. 2001;286:2568–77.

    Article  CAS  PubMed  Google Scholar 

  6. Maldonado-Martínez G, Hunter-Mellado R, Fernández-Santos D, Ríos-Olivares E. Persistent HIV viremia: description of a cohort of HIV infected individuals with ART failure in Puerto Rico. Int J Environ Res Public Health. 2015;13:50.

    Article  CAS  PubMed Central  Google Scholar 

  7. Katano H, Hishima T, Mochizuki M, et al. The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan. BMC Infect Dis. 2014;14:1–9.

    Article  Google Scholar 

  8. Wood E, Montaner JSG, Tyndall MW, et al. Prevalence and correlates of untreated human immunodeficiency virus type 1 infection among persons who have died in the era of modern antiretroviral therapy. J Infect Dis. 2003;188:1164–70.

    Article  PubMed  Google Scholar 

  9. Wood E, Kerr T, Tyndall MW, Montaner JSG. A review of barriers and facilitators of HIV treatment among injection drug users. AIDS. 2008;22:1247–56.

    Article  PubMed  Google Scholar 

  10. Weber R, Huber M, Rickenbach M, et al. Uptake of and virological response to antiretroviral therapy among HIV-infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study. HIV Med. 2009;10:407–16.

    Article  CAS  PubMed  Google Scholar 

  11. Azar P, Wood E, Nguyen P, et al. Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis. BMC Infect Dis. 2015;15:193.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Joseph B, Kerr T, Puskas CM, Montaner JSG, Wood E, Milloy MJ. Factors linked to transitions in adherence to antiretroviral therapy among HIV-infected illicit drug users in a Canadian setting. AIDS Care. 2015;27:1128–36.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–87.

    Article  PubMed  PubMed Central  Google Scholar 

  14. O’Brien ME, Clark RA, Besch CL, Myers L, Kissinger P. Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort. J Acquir Immune Defic Syndr. 2003;34:407–14.

    Article  PubMed  Google Scholar 

  15. May M, Sterne JAC, Sabin C, et al. Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies. AIDS. 2007;21:1185–97.

    Article  PubMed  Google Scholar 

  16. Ho D. Time to hit HIV, early and hard. N Engl J Med. 1995;333:450–1.

    Article  CAS  PubMed  Google Scholar 

  17. Malta M, Magnanini MMF, Strathde SA, Bastos FI. Adherence to antiretroviral therapy among HIV-infected drug users: a meta-analysis. AIDS Behav. 2010;14:731–47.

    Article  PubMed  Google Scholar 

  18. Kamarulzaman A, Altice FL. The challenges in managing HIV in people who use drugs. 2015;28:10–6.

    CAS  Google Scholar 

  19. Mills EJ, Nachega JB, Bangsberg DR, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3:e438.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kerr T, Marshall A, Walsh J, et al. Determinants of HAART discontinuation among injection drug users. AIDS Care. 2005;17:539–49.

    Article  CAS  PubMed  Google Scholar 

  21. Ware NC, Wyatt MA, Tugenberg T. Adherence, stereotyping and unequal HIV treatment for active users of illegal drugs. Soc Sci Med. 2005;61:565–76.

    Article  PubMed  Google Scholar 

  22. Ammassari A, Murri R, Pezzotti P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr. 2001;28:445–9.

    Article  CAS  PubMed  Google Scholar 

  23. Small W, Maher L, Lawlor J, Wood E, Shannon K, Kerr T. Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: social organization and systemic violence. Int J Drug Policy. 2013;24:479–87.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Linden IA, Mar MY, Werker GR, Jang K, Krausz M. Research on a vulnerable neighborhood—the Vancouver Downtown Eastside from 2001 to 2011. J Urban Heal. 2013;90:559–73.

    Article  Google Scholar 

  25. Burnett K. Commodifying poverty: gentrification and consumption in Vancouver’s downtown eastside. Urban Geogr. 2014;35:157–76.

    Article  Google Scholar 

  26. Wood E, Hogg RS, Lima VD, et al. Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA. 2008;300:550–4.

    Article  CAS  PubMed  Google Scholar 

  27. Eaton WW, Smith C, Ybarra M, et al. Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). Psychol Test Treat Plan Outcomes Assess Instrum Adults. 2004;3:363–77.

    Google Scholar 

  28. Tapp C, Milloy MJ, Kerr T, et al. Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare. BMC Infect Dis. 2011;11:86.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Milloy MJ, Wood E, Kerr T, et al. Increased prevalence of controlled viremia and decreased rates of HIV drug resistance among HIV-positive people who use illicit drugs during a community-wide treatment-as-prevention initiative. Clin Infect Dis. 2016;62:640–7.

    Article  CAS  PubMed  Google Scholar 

  30. Sangsari S, Milloy MJ, Ibrahim A, Wood E. Physician experience and rates of plasma HIV-1 RNA suppression among illicit drug users: an observational study. BMC Infect Dis. 2012;12:22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Cohen CJ, Meyers JL, Davis KL. Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV. BMJ Open. 2013;10:1136.

    Google Scholar 

  32. Nachega JB, Parienti J, Uthman O, et al. Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;58:1297–307.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Buscher A, Hartman C, Kallen MA, Giordano TP. Impact of antiretroviral dosing frequency and pill burden on adherence among newly diagnosed, antiretroviral-naive HIV patients. Int J STD AIDS. 2012;23:351–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Zhou S, Martin K, Corbett A, et al. Total daily pill burden in HIV-infected patients. AIDS Patient Care STDs. 2014;28:311–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gianotti N, Galli L, Bocchiola B, et al. Number of daily pills, dosing schedule, self-reported adherence, and health status in 2010: a large cross-sectional study of HIV-infected patients on antiretroviral therapy. HIV Med. 2013;14:153–60.

    Article  CAS  PubMed  Google Scholar 

  36. Spreen WR, Margolis DA, Pottage JC. Long-acting injectable antiretrovirals for HIV treatment and prevention. Curr Opin HIV AIDS. 2013;8:565–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Krentz HB, Cosman I, Lee K, Ming JM, Gill MJ. Pill burden in HIV infection: 20 years of experience. Antivir Ther. 2012;17:833–40.

    Article  PubMed  Google Scholar 

  38. Gandhi M, Gandhi RT. Single-pill combination regimens for treatment of HIV-1 infection. N Engl J Med. 2014;371:248–59.

    Article  CAS  PubMed  Google Scholar 

  39. Langebeek N, Gisolf E, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med. 2003;57:13–24.

    Article  PubMed  Google Scholar 

  41. Whetten K, Reif S, Whetten R, Murphy-McMillan LK. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70:531–8.

    Article  PubMed  Google Scholar 

  42. Kagee A, Delport T. Barriers to adherence to antiretroviral treatment: the perspectives of patient advocates. J Health Psychol. 2010;15:1001–11.

    Article  PubMed  Google Scholar 

  43. Smith MY, Rapkin BD, Winkel G, et al. Housing status and health care service utilization among low-income persons with HIV/AIDS. J Gen Intern Med. 2000;15:731–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Richardson LA, Kerr T, Dobrer S, et al. Socioeconomic marginalization and plasma HIV-1 RNA nondetectability among individuals who use illicit drugs in a Canadian setting. AIDS. 2015;29:2487–95.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Berg KM, Demas PA, Howard AA, et al. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004;19:1111–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank the study participants for their contributions to the research, as well as current and past researchers and staff. We would specifically like to thank: Deborah Graham, Tricia Collingham, Sarah Sheridan, Jennifer Matthews, Steve Kain, and Paul Sereda for their research and administrative assistance.

Funding

The study is supported by the US National Institutes of Health (R01-DA021525). The funders had no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Milloy is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator Award from the Canadian Institutes of Health Research. His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Dr. Montaner is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. MES is supported by a Michael Smith Foundation for Health Research (MSFHR) post-doctoral fellowship award and a Canada Addiction Medicine Research Fellowship from NIDA at the NIH (R25-DA037756). This study was funded by the United States National Institutes of Health (U01-DA02515215).

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Authors and Affiliations

  1. Faculty of Science, University of British Columbia, Vancouver, Canada

    Bianca Yeung & J. Shoveller

  2. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    N. A. Mohd Salleh, Eugenia Socías, Huiru Dong, J. S. G. Montaner & M.-J. S. Milloy

  3. Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada

    N. A. Mohd Salleh

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  1. Bianca Yeung
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  6. J. S. G. Montaner
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Correspondence to M.-J. S. Milloy.

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Conflict of interest

Dr. Milloy is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator Award from the Canadian Institutes of Health Research. His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Dr. Montaner is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. Dr. Socias is supported by a Michael Smith Foundation for Health Research (MSFHR) post-doctoral fellowship award and a Canada Addiction Medicine Research Fellowship from NIDA at the NIH (R25-DA037756). All other authors declare no conflicts of interest.

Ethical Approval

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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Yeung, B., Mohd Salleh, N.A., Socías, E. et al. Prevalence and Correlates of Reporting Difficulty Taking Antiretroviral Treatment Among HIV-Positive Illicit Drug Users in Vancouver, Canada: A Longitudinal Analysis. AIDS Behav 23, 1250–1257 (2019). https://doi.org/10.1007/s10461-018-2271-6

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