1. Material security and adherence to antiretroviral therapy among HIV-positive people who use illicit drugs
- Author
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Ekaterina Nosova, Jenna van Draanen, Lindsey Richardson, Rolando Barrios, Nur Afiqah Mohd Salleh, and M-J Milloy
- Subjects
Adult ,Male ,0301 basic medicine ,Canada ,Anti-HIV Agents ,Substance-Related Disorders ,Immunology ,Population ,MEDLINE ,HIV Infections ,Context (language use) ,Article ,Medication Adherence ,Drug Users ,03 medical and health sciences ,0302 clinical medicine ,Antiretroviral Therapy, Highly Active ,Humans ,Immunology and Allergy ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,education ,education.field_of_study ,Poverty ,Illicit Drugs ,business.industry ,Middle Aged ,Confidence interval ,030104 developmental biology ,Infectious Diseases ,HIV-positive people ,Social Marginalization ,Basic needs ,business ,Demography - Abstract
Objective To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care. Design We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 to 2017. Methods We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving at least 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three-factor structure, employed in the current analyses, were factor 1 (basic needs); factor 2 (housing-related variables) and factor 3 (economic resources). Results Recent incarceration [β-coefficient (β) = -0.176, 95% confidence interval (95% CI): -0.288 to -0.063], unmet health needs [β = -0.110, 95% CI: -0.178 to -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336 to -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586 to -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, or for each factor individually. Conclusion Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.
- Published
- 2020