Amsterdam 2015
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| Abstract #3402 - Syndemics and the Treatment Cascade | ||||
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Session: 6.2: Syndemics and the Treatment Cascade (Parallel) on Wednesday @ 11.30-13.00 in C104 Chaired by Ron Stall, Udi Davidovich Authors: Presenting Author: Prof Steven Kurtz - Nova Southeastern University, United States |
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| Additional Authors: | ||||
| Aim: Antiretroviral (ARV) non-adherence increases risks of HIV treatment failure, drug resistance, and disease transmission. Our recently completed field research among substance-using HIV-positive patients in urban south Florida documented modest levels of ARV adherence, as well as extensive diversion of ARV medications into illicit markets that directly impacts patients’ ability to achieve effective levels of adherence. Based on a syndemics analytic approach, we examined psychosocial factors that affect vulnerability to ARV diversion and low ARV adherence among highly marginalized HIV-positive individuals. | ||||
| Method / Issue: Guided by targeted sampling in high poverty and HIV prevalence areas, indigent HIV-positive substance users were recruited through direct outreach. Quota sampling ensured that approximately equal numbers of participants reported recently diverting their personal ARVs (n = 251) and not doing so (n = 252). Eligibility criteria included age 18 years or older, cocaine or heroin use 12 or more times in the prior 3 months, documented HIV-positive status, and current ARV prescription. Participants completed a standardized face-to-face interview that assessed demographics, DSM-IVR substance dependence and mental health indices, housing stability, HIV-related stigma, ARV diversion history, and past week ARV adherence levels. Multivariate logistic regression models created separate demographic, psychosocial, ARV diversion and ARV adherence profiles of participants who reported drug dependence, severe depression, recent homelessness, and high levels of HIV-related stigma. In addition, we calculated a count score (syndemic measure, range = 0 to 4) based on the number of psychosocial health problems each respondent had reported. This measure was then included as an independent variable predicting ARV diversion and 80% or higher ARV adherence. | ||||
| Results / Comments: Median age was 46 years, 59.4% male, 56.5% completed at least a high school education. Race/ethnicity: 18.1% Hispanic, 67.6% Black, 13.5% White and 0.8% other. 83.5% met DSM-IV-R criteria for substance dependence, 54.7% for severe depression, and 39.2% were homeless in the prior 3 months. Past week ARV adherence was 80% or better among 68.4% of participants. Co-occurrence of the four psychosocial health disparities was highly significant across analyses. The syndemic measure (within person counts of these problems) was linearly associated with both ARV diversion and lower ARV adherence levels. | ||||
| Discussion: Psychosocial health problems are highly inter-correlated among indigent HIV-positive substance users. Greater numbers of health problems are significantly and linearly associated with ARV diversion and low ARV adherence. Housing insecurity and HIV-related stigma appear to be especially important aggravators of the well-documented deleterious effects of substance dependence and mental illness on ARV adherence. Moreover, ARV diversion, which also directly impacts adherence, appears to have similar syndemic origins. | ||||
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