Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

Socías, María Eugenia; Milloy, M‐J

doi:10.1007/s11908-018-0636-7

Cited by 33 publications

(14 citation statements)

References 59 publications

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“…Given these barriers and the advent of newer ART regimens, it is important to characterize what level of adherence may be necessary for optimal individual-and community-level outcomes. This is particularly important among subgroups of PHIV, including PHIV who use drugs (PHIV-PWUD) who are known to be disproportionately affected by barriers to ART adherence [15]: unstable housing (e.g. homelessness, residential eviction), incarceration, food insecurity, and prohibited income generation activities are critical structural barriers to optimal HIV outcomes and likely operate through their impacts on adherence [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs

Stover

Milloy

Grant

et al. 2022

Aids

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Objectives: Owing to advances in antiretroviral therapy (ART), we re-examined minimum ART adherence levels necessary to achieve sustained HIV-1 viral load (VL) suppression among people with HIV who use drugs (PHIV-PWUD). Design and methods: We used data from ACCESS, a community-recruited prospective cohort of PHIV-PWUD in Vancouver, Canada. We calculated adherence using the proportion of days of ART dispensed in the year before each VL measurement. We used generalized linear mixed-effects models to identify adherence- and ART regimen-related correlates of VL suppression (<200 copies/ml). We employed probit regression models and generated dose–response curves to estimate the minimum adherence level needed to produce VL suppression in 90% of measures, stratified by regimen and calendar-year. Results: Among 837 ART-exposed PHIV-PWUD recruited between 1996 and 2017, the overall estimated adherence level necessary to achieve 90% VL suppression was 93% (95% confidence interval [CI]: 90–96). This differed by regimen: 69% (95% CI: 45–92) for integrase inhibitor (INSTI)-, 96% (95% CI: 92–100) for boosted protease inhibitor (bPI)-, and 98% (95% CI: 91–100) for non-nucleoside reverse transcriptase inhibitor-based regimens. In multivariable analysis, INSTI-based regimens were positively associated with VL suppression (vs. bPIs), while un-boosted PIs and other regimens were negatively associated. We observed a decreasing temporal trend of estimated adherence necessary for 90% VL suppression, dropping to 64% (95% CI: 50–77) during 2016–2017. Conclusion: Although high levels of ART adherence were necessary to achieve consistent VL suppression, the minimum necessary adherence levels decreased over time. Overall, INSTI-based regimens performed the best, suggesting that they should be preferentially prescribed to PHIV-PWUD.

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Section: Introductionmentioning

confidence: 99%

Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs

Stover

Milloy

Grant

et al. 2022

Aids

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“…One was rejected (Item 15: Drinking alcohol) while the other was undecided (Item 16: Using recreational/party drugs). This is puzzling as active substance use is reported to be a major predictor of poor ART adherence in PLHIV [ 37 ]. Furthermore, a meta-analysis found 13% of adults with HIV reported alcohol and/or substance misuse as a barrier to their ART adherence [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Content validation of a new measure of patient-reported barriers to antiretroviral therapy adherence, the I-Score: results from a Delphi study

Engler

Vicente

Mate

et al. 2022

J Patient Rep Outcomes

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Background Over a third of people living with HIV (PLHIV) have suboptimal adherence to antiretroviral therapy (ART). Measures of barriers to ART adherence often lack comprehensiveness. To help manage ART adherence barriers in HIV care, we are developing a new patient-reported outcome measure (PROM) of these barriers (the I-Score). Methods We assessed the content validity of 100 items (distinct barriers) to retain only those most relevant to both PLHIV and HIV health/social service providers. A web-based Delphi was conducted in Canada and France, collecting data from December 2018 to October 2019. Items were evaluated on relevance (the combined rated importance and actionability for HIV care of items among both PLHIV and providers); comprehensibility (rated item clarity); comprehensiveness (examined against our conceptual framework); cross-cultural equivalence (based on comparisons by questionnaire language (English, French) and country of residence). Pearson’s chi-square tests were used for comparisons by language, country, gender, and stakeholder group (PLHIV, providers). Results Panelists included 40 PLHIV and 57 providers (66% response rate). Thirty-one items were retained based on consensus thresholds for relevance (minimum: 50% for PLHIV, 60% for providers) and showed good comprehensibility and comprehensiveness, when compared to our conceptual framework (representation of: 6/6 domains, 15/20 subdomains). No significant difference in relevance based on language or country was found among retained items, suggestive of cross-cultural equivalence. Among all 100 items, only 6 significant differences on relevance were observed for gender. For 62 items, the relevance ratings of PLHIV and providers differed significantly, with providers showing greater endorsement of all items but one. Discussion The Delphi led to a much-needed item reduction. Remaining items highlight the panel’s multidimensional priorities for the PROM on ART adherence barriers, with few, if any, differences by language, country, and gender. While the analyses may lack generalizability and power, the sample size is considered adequate for a PROM validation study. Conclusion Retained items showed good content validity. The different patterns of item endorsement observed underscore the utility of engaging multiple stakeholder groups in PROM development for use in clinical practice. The greater endorsement of items by providers versus patients merits further investigation, including the implications of such differentials for measure development.

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“…Although not entirely uniform in their conclusions, many previous studies have documented detrimental effects of use of specific recreational substances and alcohol on various measures of adherence that included self-report or electronic monitoring approaches. (2, 3, 28-32) Most robust conclusions pertain to the use of amphetamines, cocaine, opioids, and alcohol. Regarding cannabis use, intensity and regularity of use may modify effects on adherence.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hazardous Alcohol and Drug Use on Antiretroviral Adherence and Hiv Viral Suppression: A Mediation Analysis

Moges

Qin

Bamford

et al. 2021

Preprint

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BackgroundLittle is known regarding the degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication adherence. We hypothesized that the total effects of such use are mediated through adherence.MethodsWe included patients with HIV (PWH) receiving care at an urban academic HIV clinic between 2014 and 2018. Eligible patients were those prescribed antiretroviral therapy who completed both patient reported outcome (PRO) questionnaires, and had subsequent plasma viral load (pVL) measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (ASSIST), and self-reported adherence. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE) and percentage mediated.ResultsAmong 3125 Patients who met eligibility criteria, percentages of current use by category were: hazardous alcohol 25.8%, cannabis 27.1%, amphetamines 13.1%, inhalants 11.9%, cocaine 5.3%, sedative-hypnotics 4.5%, opioids 2.9%, and hallucinogens 2.3%. Excellent adherence was reported in 58% and 10% had detectable pVL. Except for sedatives use of other ascertained substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR(95% CI)]: amphetamine use 2.4 (1.8 -3.2) and opioid use 2.3 (1.3 - 4.0). The percentage mediated by adherence was 36% for amphetamine use, 26.5% for opioid use, and 39% for multiple substance use.ConclusionUse of amphetamines, opioids, and multiple substances predicted detectable pVL. However, less than 40% of effects were mediated by self-reported adherence.SummaryWe examined adherence-mediated effects of hazardous alcohol and substance use on HIV viral suppression. Use of amphetamines, opioids, and multiple substance predicted detectable viral load, however, less than 40% of effects were mediated by self-reported antiretroviral adherence.

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Substance Use and Adherence to Antiretroviral Therapy: What Is Known and What Is Unknown

Cited by 33 publications

References 59 publications

Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs

Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs

Content validation of a new measure of patient-reported barriers to antiretroviral therapy adherence, the I-Score: results from a Delphi study

Effects of Hazardous Alcohol and Drug Use on Antiretroviral Adherence and Hiv Viral Suppression: A Mediation Analysis

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