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AIDS. 2020 Feb 17. doi: 10.1097/QAD.0000000000002501. [Epub ahead of print]

Material security and adherence to antiretroviral therapy (ART) among HIV-positive people who use illicit drugs.

Author information

1
Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada.
2
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
3
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
4
Department of Sociology, University of British Columbia, Vancouver, BC, Canada.
5
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
6
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
7
Vancouver Coastal Health, Vancouver, British Columbia, Canada.

Abstract

OBJECTIVE:

To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care.

DESIGN:

We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 - 2017.

METHODS:

We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving ≥ 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three factors structure, employed in the current analyses, were Factor 1 (basic needs); Factor 2 (housing-related variables) and Factor 3 (economic resources).

RESULTS:

Recent incarceration [β-coefficient (β) = -0.176, 95% Confidence Interval [95%CI]: -0.288, -0.063), unmet health needs (β = -0.110, 95% CI: -0.178, -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336, -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586, -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, as well as for each factor individually.

CONCLUSION:

Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.

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