Socioeconomic and psychosocial factors are associated with poor treatment outcomes in Australian adults living with HIV: a case-control study
Krista J. Siefried
A B G , Stephen Kerr A , Robyn Richardson A , Limin Mao C , John Rule D E , John McAllister A , John de Wit C F and Andrew Carr A
+ Author Affiliations
- Author Affiliations
A St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia.
B National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW 2052, Australia.
C Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia.
D National Association of People with HIV Australia, 1 Erskineville Road, Newtown, NSW 2042, Australia.
E School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
F Department of Interdisciplinary Social Science, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands.
G Corresponding author. Email: krista.siefried@svha.org.au
Sexual Health 16(6) 548-553 https://doi.org/10.1071/SH18138
Submitted: 30 July 2018 Accepted: 16 April 2019 Published: 13 September 2019
Journal Compilation © CSIRO 2019 Open Access CC BY-NC-ND
Abstract
Background: A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. Methods: Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. Results: Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load >50 copies mL–1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3–7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0–9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5–9.7, P = 0.004). Conclusions: Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.
Additional keywords: antiretroviral therapy, ART failure, finance, HIV cascade.
References
[1] Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011; 52 793–800.| The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection.Crossref | GoogleScholarGoogle Scholar | 21367734PubMed |
[2] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: University of New South Wales; 2018.
[3] The Joint United Nations Programme on HIV/AIDS (UNAIDS). 90–90–90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
[4] Lazarus JV, Safreed-Harmon K, Barton SE, Costagliola D, Dedes N, Del Amo Valero J, et al. Beyond viral suppression of HIV – the new quality of life frontier. BMC Med 2016; 14 94
| Beyond viral suppression of HIV – the new quality of life frontier.Crossref | GoogleScholarGoogle Scholar | 27334606PubMed |
[5] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services; 2018. Available online at: https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf [verified 19 June 2019].
[6] Lifson AR, Belloso WH, Davey RT, Duprez D, Gatell JM, Hoy JF, et al. Development of diagnostic criteria for serious non-AIDS events in HIV clinical trials. HIV Clin Trials 2010; 11 205–19.
| Development of diagnostic criteria for serious non-AIDS events in HIV clinical trials.Crossref | GoogleScholarGoogle Scholar | 20974576PubMed |
[7] McNairy ML, Abrams EJ, Rabkin M, El-Sadr WM. Clinical decision tools are needed to identify HIV-positive patients at high risk for poor outcomes after initiation of antiretroviral therapy. PLoS Med 2017; 14 e1002278
| Clinical decision tools are needed to identify HIV-positive patients at high risk for poor outcomes after initiation of antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 29112963PubMed |
[8] Pence BW, Ostermann J, Kumar V, Whetten K, Thielman N, Mugavero MJ. The influence of psychosocial characteristics and race/ethnicity on the use, duration, and success of antiretroviral therapy. J Acquir Immune Defic Syndr 2008; 47 194–201.
| The influence of psychosocial characteristics and race/ethnicity on the use, duration, and success of antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 17971712PubMed |
[9] Zaragoza-Macias E, Cosco D, Nguyen ML, Del Rio C, Lennox J. Predictors of success with highly active antiretroviral therapy in an antiretroviral-naive urban population. AIDS Res Hum Retroviruses 2010; 26 133–8.
| Predictors of success with highly active antiretroviral therapy in an antiretroviral-naive urban population.Crossref | GoogleScholarGoogle Scholar | 20156096PubMed |
[10] Legarth R, Omland LH, Kronborg G, Larsen CS, Pedersen C, Gerstoft J, et al. Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients. AIDS 2014; 28 387–96.
| Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients.Crossref | GoogleScholarGoogle Scholar | 24670524PubMed |
[11] Milloy MJ, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, et al. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS 2012; 26 60–7.
| Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting.Crossref | GoogleScholarGoogle Scholar | 22107040PubMed |
[12] Milloy MJ, Kerr T, Buxton J, Rhodes T, Krusi A, Guillemi S, et al. Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. J Acquir Immune Defic Syndr 2012; 59 393–9.
| Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 22134149PubMed |
[13] Shacham E, Nurutdinova D, Onen N, Stamm K, Overton ET. The interplay of sociodemographic factors on virologic suppression among a U.S. outpatient HIV clinic population. AIDS Patient Care STDS 2010; 24 229–35.
| The interplay of sociodemographic factors on virologic suppression among a U.S. outpatient HIV clinic population.Crossref | GoogleScholarGoogle Scholar | 20397898PubMed |
[14] Simoni JM, Yard SS, Huh D. Prospective prediction of viral suppression and immune response nine months after ART initiation in Seattle, WA. AIDS Care 2013; 25 181–5.
| Prospective prediction of viral suppression and immune response nine months after ART initiation in Seattle, WA.Crossref | GoogleScholarGoogle Scholar | 22639986PubMed |
[15] McFall AM, Dowdy DW, Zelaya CE, Murphy K, Wilson TE, Young MA, et al. Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity. J Acquir Immune Defic Syndr 2013; 64 289–98.
| Understanding the disparity: predictors of virologic failure in women using highly active antiretroviral therapy vary by race and/or ethnicity.Crossref | GoogleScholarGoogle Scholar | 23797695PubMed |
[16] Burch L, Smith C, Anderson J, Sherr L, Rodger A, O’Connell R, et al. Socio-economic factors and virological suppression among people diagnosed with HIV in the United Kingdom: results from the ASTRA study. J Int AIDS Soc 2014; 17 19533
| Socio-economic factors and virological suppression among people diagnosed with HIV in the United Kingdom: results from the ASTRA study.Crossref | GoogleScholarGoogle Scholar | 25394042PubMed |
[17] Rosin C, Elzi L, Thurnheer C, Fehr J, Cavassini M, Calmy A, et al. Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study. HIV Med 2015; 16 319–25.
| Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study.Crossref | GoogleScholarGoogle Scholar | 25329751PubMed |
[18] Burch LS, Smith CJ, Phillips AN, Johnson MA, Lampe FC. Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review. AIDS 2016; 30 1147–61.
| Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review.Crossref | GoogleScholarGoogle Scholar | 26919732PubMed |
[19] McAllister J, Beardsworth G, Lavie E, Macrae K, Carr A. Financial stress is associated with reduced treatment adherence in HIV-infected adults in a resource-rich setting. HIV Med 2013; 14 120–4.
| Financial stress is associated with reduced treatment adherence in HIV-infected adults in a resource-rich setting.Crossref | GoogleScholarGoogle Scholar | 22780330PubMed |
[20] Siefried KJ, Mao L, Kerr S, Cysique LA, Gates TM, McAllister J, et al. Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression. PLoS One 2017; 12 e0174613
| Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression.Crossref | GoogleScholarGoogle Scholar | 28369066PubMed |
[21] Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 606–13.
| The PHQ-9: validity of a brief depression severity measure.Crossref | GoogleScholarGoogle Scholar | 11556941PubMed |
[22] Mao L, Kippax SC, Newman CE, Andrews G, Rogers G, Saltman DC, et al. Rates of depression among men attending high-HIV-caseload general practices in Australia. Ment Health Fam Med 2008; 5 79–83.
| 22477852PubMed |
[23] Duracinsky M, Herrmann S, Berzins B, Armstrong AR, Kohli R, Le Coeur S, et al. The development of PROQOL-HIV: an international instrument to assess the health-related quality of life of persons living with HIV/AIDS. J Acquir Immune Defic Syndr 2012; 59 498–505.
| The development of PROQOL-HIV: an international instrument to assess the health-related quality of life of persons living with HIV/AIDS.Crossref | GoogleScholarGoogle Scholar | 22205438PubMed |
[24] Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS 2002; 16 605–13.
| Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study.Crossref | GoogleScholarGoogle Scholar | 11873004PubMed |
[25] Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA 1984; 252 1905–7.
| Detecting alcoholism: the CAGE questionnaire.Crossref | GoogleScholarGoogle Scholar | 6471323PubMed |
[26] Guck TP, Goodman MD, Dobleman CJ, Fasanya HO, Tadros MB. Relationship between acceptance of HIV/AIDS and functional outcomes assessed in a primary care setting. AIDS Care 2010; 22 89–95.
| 20390485PubMed |
[27] Horne R, Buick D, Fisher M. Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART. Int J STD AIDS 2004; 15 38–44.
| Doubts about necessity and concerns about adverse effects: identifying the types of beliefs that are associated with non-adherence to HAART.Crossref | GoogleScholarGoogle Scholar | 14769170PubMed |
[28] Prestage G, Mao L, Kippax S, Jin F, Hurley M, Grulich A, et al. Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS Behav 2009; 13 645–51.
| Use of viral load to negotiate condom use among gay men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 19199021PubMed |
[29] Prestage G, McCann P, Hurley M, Bradley J, Down I, Brown G. Pleasure and sexual health: the PASH study. Sydney: The National Centre in HIV Epidemiology and Clinical Research; 2009.
[30] Stutterheim SE, Pryor JB, Bos A, Hoogendjik R, Muris P, Schaalma H. HIV-related stigma and psychological stress: the harmful effects of specific stigma manifestations in various social settings. AIDS 2009; 23 2353–7.
| HIV-related stigma and psychological stress: the harmful effects of specific stigma manifestations in various social settings.Crossref | GoogleScholarGoogle Scholar | 19741478PubMed |
[31] Maruff P, Thomas E, Cysique L, Brew B, Collie A, Snyder P, et al. Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Arch Clin Neuropsychol 2009; 24 165–78.
| Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex.Crossref | GoogleScholarGoogle Scholar | 19395350PubMed |
[32] Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol 2013; 68 197–209.
| A pandemic of the poor: social disadvantage and the U.S. HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 23688088PubMed |
[33] Tabachnick BG, Fidell LS. Using multivariate statistics. 6th edn. Boston: Allyn & Bacon; 2012.
[34] Pearson RH, Mundform DJ. Recommended sample size for conducting exploratory factor analysis on dichotomous data. J Mod Appl Stat Methods 2010; 9 359–68.
| Recommended sample size for conducting exploratory factor analysis on dichotomous data.Crossref | GoogleScholarGoogle Scholar |
[35] Comrey AL, Lee HB. A first course in factor analysis. Hillsdale: L. Erlbaum Associates; 1992.
[36] Kass RA, Tinsley HEA. Factor analysis. J Leis Res 1979; 11 120–38.
| Factor analysis.Crossref | GoogleScholarGoogle Scholar |
