Adherence to HIV Treatment Heavily Influenced by Environmental Factors

Antiretroviral therapy use and viral suppression heavily impacted by issues such as poverty and race.

A recent study found that environmental factors contribute to antiretroviral therapy (ART) adherence, appointment attendance for care, and viral suppression for adolescents and young adults living with HIV in the United States.

This conclusion was drawn from examining the association between structural and individual level factors, as well as data for patients currently on ART, had been on ART for at least 6 months, had missed 1 or more HIV care appointment over the past 12 months, and viral suppression.

The study published in PLOS ONE included 1891 individuals with HIV (27.8% perinatally infected and 72.2% behaviorally infected) and 733 distinct zip code tabulation areas (ZCTAs).

Participants were linked to care through 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions Units (ATN), and who were given an audio computer-assisted self-interview survey.

Additionally, blood was drawn to provide researchers with viral load data.

Geographic-level variables were taken from the United States Census Bureau and Esri Crime databases as ZCTAs. Since numerous health departments do not disclose the number of diagnosed HIV cases by zip code, AIDSVu data was extracted at a county-level.

Environmental factors were defined as living in in poverty, chronic unemployment, high rates of school dropout, segregation, and health risk factors that do not exist in more advantaged neighborhoods.

“At their core, many theories posit that environments with structural disadvantages are negatively impacted through decreased collective efficacy and social cohesion, which in turn many affect the individual’s ability to engage in health seeking behaviors (eg, engage in or be maintained in HIV care),” the study authors wrote.

The majority of participants in the study were African American (n = 1314, 69.49%) and men (n = 1205, 63.72%) who were behaviorally infected with HIV (n = 1366, 72.24%). The results of the study reported that more than half of individuals currently used ART (n = 1120, 59.23%), while less than half (n = 861, 45.53%) reported ART use for at least 6 months.

Less than one-third of participants were virally suppressed (n = 577, 30.51%), and at least 1 HIV care appointment was missed over the year (n = 936, 49.50%). Once results were adjusted for individual-level factors, youth who lived in more disadvantaged areas were less likely to report current use of ART (OR: 0.85, 95% CI: 0.72—1.00, p = .05).

Individuals currently taking ART who lived in disadvantaged areas were associated with a greater likelihood of having used ART for ≥6 months. Participants who lived in counties with greater HIV prevalence among 13- to 24-year-olds were more likely to report current ART use (OR: 1.32, 95% CI: 1.05—1.65, p = .02), ≥6 months ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), and to be virally suppressed (OR: 1.50, 95% CI: 1.20–1.87, p = .001).

However, youth in these areas were more likely to report missed HIV medical care appointments (OR: 1.32, 95% CI: 1.07—1.63, p = .008). The findings show that ecological factors play a role in HIV treatment, and the study authors stress that researchers and clinicians should consider these factors when implementing interventions.

Furthermore, heath care policies and legislation that address and incorporate these broader structural contexts and demographics should be used in conjunction with resource allocation to help ensure more positive health outcomes.