Factors Associated with ART Adherence among MSM Receiving Medical Care in Texas: An Analysis of the Texas Medical Monitoring Project Data

Abstract

Objective(s): To examine the sociodemographic, behavioral, and clinical characteristics associated with 100% ART adherence and sustained viral suppression (SVS) among men who have sex with men (MSM) living with HIV and receiving HIV-related medical care in Texas. Design: A cross-sectional, three-stage design was used to sample jurisdictions, facilities, and HIV patients receiving medical care, using probability-proportional-to-size methods. Methods: Medical record abstraction and interview data (n = 1,426) from the 2009-2014 Medical Monitoring Project (MMP) cycles were used for this analysis. The associations between the sociodemographic, behavioral, and clinical characteristics with both 100% ART adherence and SVS were assessed using Rao-Scott chi-square tests. Multivariable logistic regression models were derived to estimate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CI) for 100% ART adherence and SVS. Results: Of the MSM participants, 84% reported 100% ART adherence and 65% had SVS. Younger (age <55 years) and Black MSM who reported housing/food/income unmet needs were less likely to be 100% ART adherence or attain SVS (p<0.05 for all). Conversely, those who were 100% ART adherent were more likely to have SVS (p<0.05). Compared to MSM ≥55 years, those 18-34, 35-44, and 45-54 years were 34%, 23%, and 15% less likely to achieve SVS, respectively. Additionally, compared to White MSM, Black MSM were 13% less likely to achieve SVS and with adjustment of ART adherence, this association remained statistically significant (p<0.05). MSM who were 100% adherent to ART were 24% more likely to achieve SVS compared to those who were not completely adherent. Conclusions: Our study identified age, race/ethnicity, homelessness, and unmet needs for housing/food/income as major predictors of 100% ART adherence and SVS among MSM living with HIV and receiving medical care in Texas. Since MSM comprise the majority of people living with HIV in Texas, addressing these differences in SVS and ART adherence based on their sociodemographic, behavioral, and HIV-related characteristics is critical to meeting goals set to end the HIV epidemic in Texas.