Amsterdam 2015
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| Abstract #2183 - Migration and HIV | ||||
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Session: 22.4: Migration and HIV (Parallel) on Wednesday @ 16.30-18.00 in C002 Chaired by Christiana Noestlinger, Dolores Albarracin Authors: Presenting Author: Ms Sabrina Been - Erasmus Medical Centre, Netherlands |
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| Additional Authors: | ||||
| Aim: Several studies have shown that, in the Netherlands, non-European immigrants with HIV have poorer psychosocial and treatment outcomes than Dutch patients. This is important because more than 34% of people living with HIV (PLWH) in clinical care in the Netherlands originate from outside of Western Europe. This study’s aim was to identify risk factors influencing adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. | ||||
| Method / Issue: A cross-sectional study was performed between October 2012 and July 2013 among immigrant PLWH visiting outpatient clinics at the Erasmus Medical Centre and Maasstad Hospital. In total, 857 immigrants were eligible, of which 354 agreed to participate (response=41.3%). Socio-demographic and clinical characteristics (i.e., HIV-RNA and CD4 cell count) for all patients were collected from the Dutch HIV Monitoring Foundation database. Trained interviewers subsequently completed questionnaires together with consenting patients in Dutch, English, French, Spanish, or Portuguese in order to gather additional relevant socio-demographic information (i.e., education), psychosocial characteristics (i.e., social support), and information regarding self-reported adherence. Uni- and multivariable logistic regression analyses were conducted to determine risk factors for self-reported non-adherence for the 302 patients who had used cART in the 6 months prior to inclusion (cART experienced). The multivariable analyses included all variables with P<0.1 in univariable analyses. | ||||
| Results / Comments: Baseline characteristics: Of the 354 patients that participated, 94.6% were first generation, with many originating from Sub-Saharan Africa (41.0%). About two-thirds (62.7%) self-identified as heterosexual and 16.7% reported being a single parent. A total of 39.0% lived with family while 36.7% lived alone. Also, 23.2% reported having no formal education or only primary school, 26.0% were unemployed, and 43.2% were in paid employment. No statistically significant differences between participants and non-participants were present, except for cART status and HIV-RNA >50 copies/ml. Specifically, the participants group contained more cART experienced patients (86.3% versus 77.4%) and less patients with HIV-RNA >50 copies/ml when cART experienced (10.9% versus 17.4%). Factors associated with non-adherence: Among cART experienced patients, 52.7% were non-adherent. Three independent risk factors for non-adherence (P<0.05) were found: (I) not having attended formal education or only primary school (OR=3.28, 95% CI: 1.29-8.32, versus University), (II) experiencing low social support (OR=2.52, 95% CI: 1.34-4.74), and (III) reporting low treatment adherence self-efficacy (OR=3.06, 95% CI: 1.62-5.77). HIV-RNA >50 copies/ml and internalized HIV-stigma were also marginally associated (P<0.1) with non-adherence (OR=2.54, 95% CI: 0.91-7.06 and OR=1.76, 95% CI: 0.95-3.33). | ||||
| Discussion: This study reports on risk factors for non-adherence to cART within a large sample of immigrant PLWH living in a high income, low prevalence locale (i.e., the Netherlands). Patients who have not attended formal education or only primary school, who experience low social support, or who have low treatment adherence self-efficacy are most at risk for non-adherence and should be offered more intensive counselling and support. Our study participants may represent a better performing population, suggesting that these risk factors could be even more relevant in the total eligible population. Theory and evidence-based interventions that aim to improve adherence to cART should therefore take these factors into consideration. | ||||
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