Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression
Identifieur interne : 000222 ( Main/Exploration ); précédent : 000221; suivant : 000223Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression
Auteurs : Krista J. Siefried [Australie] ; Limin Mao [Australie] ; Stephen Kerr [Australie] ; Lucette A. Cysique [Australie] ; Thomas M. Gates [Australie] ; John Mcallister [Australie] ; Anthony Maynard [Australie] ; John De Wit [Australie, Pays-Bas] ; Andrew Carr [Australie]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings.
Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression.
We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012).
In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support.
Url:
DOI: 10.1371/journal.pone.0174613
PubMed: 28369066
PubMed Central: 5378347
Affiliations:
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Siefried</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Mao, Limin" sort="Mao, Limin" uniqKey="Mao L" first="Limin" last="Mao">Limin Mao</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Kerr, Stephen" sort="Kerr, Stephen" uniqKey="Kerr S" first="Stephen" last="Kerr">Stephen Kerr</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Cysique, Lucette A" sort="Cysique, Lucette A" uniqKey="Cysique L" first="Lucette A." last="Cysique">Lucette A. Cysique</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation><affiliation><nlm:aff id="aff003"><addr-line>Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales Australia</addr-line></nlm:aff><wicri:noCountry code="subfield">New South Wales Australia</wicri:noCountry></affiliation></author><author><name sortKey="Gates, Thomas M" sort="Gates, Thomas M" uniqKey="Gates T" first="Thomas M." last="Gates">Thomas M. Gates</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Mcallister, John" sort="Mcallister, John" uniqKey="Mcallister J" first="John" last="Mcallister">John Mcallister</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Maynard, Anthony" sort="Maynard, Anthony" uniqKey="Maynard A" first="Anthony" last="Maynard">Anthony Maynard</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>National Association of People with HIV Australia, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>National Association of People with HIV Australia, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="De Wit, John" sort="De Wit, John" uniqKey="De Wit J" first="John" last="De Wit">John De Wit</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff005"><addr-line>Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Interdisciplinary Social Science, Utrecht University, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region><settlement type="city">Utrecht</settlement></placeName><orgName type="university">Université d'Utrecht</orgName></affiliation></author><author><name sortKey="Carr, Andrew" sort="Carr, Andrew" uniqKey="Carr A" first="Andrew" last="Carr">Andrew Carr</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Missing more than one tablet of contemporary antiretroviral therapy (ART) per month increases the risk of virological failure. Recent studies evaluating a comprehensive range of potential risk factors for suboptimal adherence are not available for high-income settings.</p></sec><sec id="sec002"><title>Methods</title><p>Adults on ART with undetectable viral load (UDVL) were recruited into a national, multi-centre cohort, completing a comprehensive survey assessing demographics, socio-economic indicators, physical health, well-being, life stressors, social supports, HIV disclosure, HIV-related stigma and discrimination, healthcare access, ART regimen, adherence, side effects, costs and treatment beliefs. Baseline data were assessed, and suboptimal adherence was defined as self-reported missing ≥1 ART dose/month over the previous 3-months; associated factors were identified using bivariate and multivariate binary logistic regression.</p></sec><sec id="sec003"><title>Results</title><p>We assessed 522 participants (494 [94.5%] men, mean age = 50.8 years, median duration UDVL = 3.3 years [IQR = 1.2–6.8]) at 17 sexual health, hospital, and general practice clinics across Australia. Seventy-eight participants (14.9%) reported missing ≥1 dose/month over the previous three months, which was independently associated with: being Australian-born (AOR [adjusted odds ratio] = 2.4 [95%CI = 1.2–4.9], p = 0.014), not being in a relationship (AOR = 3.3 [95%CI = 1.5–7.3], p = 0.004), reaching the “Medicare safety net” (capping annual medical/pharmaceutical costs) (AOR = 2.2 [95%CI = 1.1–4.5], p = 0.024), living in subsidised housing (AOR = 2.5 [95%CI = 1.0–6.2], p = 0.045), receiving home-care services (AOR = 4.4 [95%CI = 1.0–18.8], p = 0.046), HIV community/outreach services linkage (AOR = 2.4 [95%CI = 1.1–5.4], p = 0.033), and starting ART following self-request (AOR = 3.0 [95%CI = 1.3–7.0], p = 0.012).</p></sec><sec id="sec004"><title>Conclusions</title><p>In this population, 15% reported recent suboptimal ART adherence at levels associated in prospective studies with subsequent virological failure, despite all having an undetectable viral load. Associations were with social/economic/cultural/patient engagement factors, but not ART regimen/clinical factors. These associations may help identify those at higher risk of future virological failure and guide patient education and support.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cohen, Ms" uniqKey="Cohen M">MS Cohen</name></author><author><name sortKey="Chen, Yq" uniqKey="Chen Y">YQ Chen</name></author><author><name sortKey="Mccauley, M" uniqKey="Mccauley M">M McCauley</name></author><author><name sortKey="Gamble, T" uniqKey="Gamble T">T Gamble</name></author><author><name sortKey="Hosseinipour, Mc" uniqKey="Hosseinipour M">MC Hosseinipour</name></author><author><name sortKey="Kumarasamy, N" uniqKey="Kumarasamy N">N Kumarasamy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murray, Js" uniqKey="Murray J">JS Murray</name></author><author><name sortKey="Elashoff, Mr" uniqKey="Elashoff M">MR Elashoff</name></author><author><name sortKey="Iacono Connors, Lc" uniqKey="Iacono Connors L">LC 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name="Australie"><noRegion><name sortKey="Siefried, Krista J" sort="Siefried, Krista J" uniqKey="Siefried K" first="Krista J." last="Siefried">Krista J. 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Gates</name><name sortKey="Kerr, Stephen" sort="Kerr, Stephen" uniqKey="Kerr S" first="Stephen" last="Kerr">Stephen Kerr</name><name sortKey="Mao, Limin" sort="Mao, Limin" uniqKey="Mao L" first="Limin" last="Mao">Limin Mao</name><name sortKey="Maynard, Anthony" sort="Maynard, Anthony" uniqKey="Maynard A" first="Anthony" last="Maynard">Anthony Maynard</name><name sortKey="Mcallister, John" sort="Mcallister, John" uniqKey="Mcallister J" first="John" last="Mcallister">John Mcallister</name></country><country name="Pays-Bas"><region name="Utrecht (province)"><name sortKey="De Wit, John" sort="De Wit, John" uniqKey="De Wit J" first="John" last="De Wit">John De Wit</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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