Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

McCarthy, Meghan; Tao, Jun; Lerebours, Alain; Rodríguez, Claudia; Flanigan, Timothy P.; Sanchez, Martha

doi:10.1177/23259582221096522

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…This proportion was consistently similar in all the population demographic strata. This is similar to findings published from other regions, such as Guatemala in Central America ( 18 ) and the Dominican Republic in the Caribbean region ( 19 ). This suggests that such outcomes are attainable in diverse settings.…”

Section: Discussionsupporting

confidence: 90%

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

Kafwanka

Nalule²,

Michelo³

2023

Front. Public Health

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BackgroundCoronavirus disease 2019 (COVID-19)-related disruptions in healthcare services and clinical outcomes have been predicted and documented. However, little is known about how antiretroviral therapy (ART) adherence disruptions caused by the COVID-19 pandemic have manifested amidst the ‘Undetectable = Untransmittable' campaign initiative. Using a patient's viral load as a proxy for medication adherence, our study aimed to determine the adherence to ART on first-line medications among adult people living with human immunodeficiency virus (PLWHIV) at the University Teaching Hospital in Lusaka, Zambia during the pandemic.MethodsThis was a hospital-based cross-sectional study. Secondary data of PLWHIV registered to receive ART from the Adult Infectious Disease Centre was extracted from the SmartCare® electronic health record system to constitute a resultant data set that this study used. The data extraction form was used to extract values of dependent (ART adherence measured by viral load detectability) and independent variables and imported them into the statistical analysis tool, STATA version 16.1 MP. Descriptive statistics of individual characteristics, testing for associations using Pearson's chi-square test, and stratified and combined multivariable logistic regression were performed.ResultsOf the 7,281 adult PLWHIV included in this study, 9.0% (95% CI 8.3–9.6%) were virally detectable. Estimates of the odds ratios of detectable viral load remained significantly higher among adult PLWHIV who were initiated on ART after the U=U campaign was launched in Zambia and were on a monthly 2.51 (1.31–9.03) or 6-monthly 4.75 (3.52–6.41) dispensing of a dolutegravir-based regimen and those on 6-monthly dispensing of an efavirenz-based regimen 4.67 (2.16–10.08) compared to their counterparts. Overall estimates showed us the same picture 4.14 (3.22–5.31), having adjusted for all other predictor variables.ConclusionWe found that a high proportion of people with detectable viral load in the study population, irrespective of medication refill interval and type of regimen, was concentrated among adult PLWHIV who started treatment during the COVID-19 epidemic waves, as compared to those who started treatment before the pandemic. This observed disparity suggests the inherent impact of the pandemic on the adherence to ART among adult PLWHIV in Lusaka, Zambia. This further illustrates how exposed program responses are to external shocks, especially in already weakened health systems, and the need to create program response buffers and resilient program-specific strategies to minimize the effect of external disruptions.

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Section: Discussionsupporting

confidence: 90%

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

Kafwanka

Nalule²,

Michelo³

2023

Front. Public Health

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“…This study associated higher levels of stigma with higher odds of missing an ART dose [ 25 ]. A study evaluating barriers to viral suppression among PLHIV in the DR found that male and employed patients were more likely not to be virally suppressed, partially due to stigma that limited engagement in care [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Along with stigma, low social support has been widely recognized as a factor adversely affecting engagement in HIV care [ 26 ]. In a DR-based study with WLHIV, participants described controlling disclosure, educating self and others about HIV, and seeking support from family, friends, or others [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

Celeste-Villalvir,

Payan,

Armenta

et al. 2023

PLoS ONE

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HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.

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Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

Cited by 2 publications

References 27 publications

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

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