Is substance use associated with HIV cascade outcomes in Latin America?

Raquel B De Boni,Claudia Cortés,Denis Padgett,Stephany N Duda,Catherine C Mcgowan,Meridith B Peratikos,Bryan E Shepherd,Beatriz Grinsztejn,Eduardo Gotuzzo,Peter F Rebeiro,Pablo F Belaunzarán-Zamudio,Dimitrios Paraskevis

doi:10.1371/journal.pone.0194228

Abstract

BackgroundThe HIV care cascade has improved in Latin America over the last decade. However, the influence of alcohol and noninjected drug use (NIDU) on cascade outcomes is mostly unknown. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF).MethodsIndividuals ≥18 years attending routine HIV clinic visits and completing the Rapid Screening Tool (RST; evaluating NIDU and ART adherence in 7-day recall period) during 2012–13 were followed up to 2015 in the Caribbean, Central and South America network for HIV epidemiology. Adjusted odds ratios (aOR) were calculated for the association of alcohol consumption and NIDU with retention in care by logistic regression; adjusted hazard ratios (aHR) were estimated for the associations with LTFU and VF by Cox regression.ResultsAmong 3604 individuals, the proportions retained in care for one year were 84%, 79%, 72%, and 69% for patients reporting non-use, alcohol use, NIDU, and both alcohol and NIDU, respectively. For the same patient groups, the proportions LTFU over 18 months were 6%, 8%, 12%, and 13%, respectively. There were 1901 patients (53%) with HIV RNA results; VF proportions were similar between users and nonusers (ranging from 14–16%). After controlling for age, sex, study site, HIV transmission mode, time on ART, AIDS status, and CD4 count, neither alcohol use (aOR = 1.1, CI = 0.9–1.4; aHR = 1.0, CI = 0.8–1.3) nor NIDU (aOR = 1.3, CI = 0.9–1.8; aHR = 1.4, CI = 0.9–2.1) were significantly associated with retention or VF, respectively. However, both alcohol use (aHR = 1.2, CI = 1.02–1.4) and NIDU (aHR = 1.3, CI = 1.00–1.8) were associated with increased LTFU.ConclusionAlcohol use and NIDU in a 7-day recall period increased the risk of being LTFU during the next 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART.

Highlights

The HIV cascade of care [1,2,3] is a powerful framework to describe and monitor the complex and dynamic process of HIV infection treatment using well-defined, specific stages of care
Alcohol use and noninjected drug use (NIDU) in a 7-day recall period increased the risk of being loss to follow up (LTFU) during the 18 months, highlighting the need for routine screening and targeted interventions to keep these individuals in care and on ART
The present study aims to expand the understanding of these two interconnected epidemics in Latin America benefiting from CCASAnet data to estimate the association of alcohol and NIDU with three HIV cascade outcomes: 1) retention in care, 2) loss to follow up (LTFU) and 3) virologic failure (VF)

Summary

Introduction

The HIV cascade of care [1,2,3] is a powerful framework to describe and monitor the complex and dynamic process of HIV infection treatment using well-defined, specific stages of care. The main stages, or outcomes, of the care cascade are HIV diagnosis, linkage and retention in care, combination antiretroviral therapy (cART) use, and viral suppression. Alcohol and noninjected drug use (NIDU) were associated with lower retention in care [9,10] and a history of NIDU decreased the chance of returning to care after a treatment gap [11]. This is important because retention/engagement in care is critical to starting cART and to achieving viral suppression [12]. This study estimated the association of alcohol and NIDU with retention in care, loss to follow up (LTFU), and virologic failure (VF)

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Results

Conclusion