Abstract
BackgroundSelf-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care. One-seventh of all those living with HIV pass through incarceration annually and criminal-justice (CJ) involved people living with HIV (PLH) are vulnerable to falling out of care. We examined the association of self-reported ART adherence with VL in a criminal-justice sample compared to a routine-care sample.MethodsSamples: We examined data from a multisite collaboration of studies addressing the continuum of HIV care among CjJ involved persons in the Seek, Test, Treat, and Retain cohort. Data pooled from seven CJ- studies (n = 414) were examined and compared with the routine-care sample from the Centers for AIDS Research Network of Integrated Clinical Systems’ seven sites (n = 11,698).Measures: In both samples, data on self-reported percent ART doses taken were collected via the visual analogue scale adherence measure. Viral load data were obtained by blood-draw.Analysis: We examined the associations of adherence with VL in both cohorts using mixed effects linear regression of log-VL, and mixed effects logistic regression of binary VL (≥ 200 copies/mL) outcomes. Interactions by CD4 count and self-reported health status were also tested.ResultsAmong the CJ sample, the coefficient for log-VL was − 0.31 (95% CI = − 0.43, − 0.18; P < 0.01) and that in the routine-care sample was − 0.42 (95% CI = − 0.45, − 0.38; P < 0.01). For the logistic regression of binary detectable VL on 10% increments of adherence we found the coefficient was − 0.26 (95% CI = − 0.37, − 0.14; P < 0.01) and in the routine-care sample it was − 0.38 (95% CI = − 0.41, − 0.35; P < 0.01). There was no significant interaction by CD4 count level in the CJ sample, but there was in the routine-care sample. Conversely, there was a significant interaction by self-reported health status level in the criminal-justice sample, but not in the routine-care sample.ConclusionsThe visual analogue scale is valid and useful to measure ART adherence, supporting treatment for CJ- involved PLH vulnerable to falling out of care. Research should examine adherence and VL in additional populations.
Highlights
Self-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care
Descriptive characteristics Comparing 414 criminal justice-involved people living with human Immunodeficiency virus (HIV) from STTR with 11,698 persons in routine HIV care from Clinical Systems (CNICS) (Table 2), the criminal justiceinvolved persons were significantly more likely to have a detectable VL (26% vs. 12%), greater mean log-VL, smaller proportion with ART adherence scores ≥ 95% (59% vs. 70%), and smaller proportions of ART regimens containing either Protease Inhibitors (PI) (28% vs. 41%) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) (23% vs. 42%), or INSTI regimens (5% vs. 22%; Table 2)
Associations of visual analogue scale (VAS) adherence with viral load We examined the association between VL and adherence using mixed effects regression analyses and found, among the criminal justice sample the relative VL was 0.73 indicating that each 10% increment in adherence was associated with a reduction in VL of 27% (1-relative VL%)
Summary
Self-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care. Self-report data, often underestimate real-world adherence and are susceptible to recall and social desirability bias [3, 4] These weaknesses may be problematic among those with substance use disorders, mental illness, low income or lower education/literacy levels, and/or unstable housing, which are common among criminal justice-involved persons [5,6,7,8,9]. As 1 in 7 people living with HIV cycle through criminal justice settings each year [10], clinicians may benefit from self-reported ART adherence measures that correlate well with viral suppression among the criminal justice-involved persons they may treat In this population, frequent measurement of VL is challenging, especially among those recently released from criminal justice settings who often are out of clinical care [5, 7, 8, 11]. If any, previous studies have examined the association of self-reported adherence with plasma VL among criminal justice-involved persons in multiple U.S sites
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