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AIDS Behav. 2016 Apr;20(4):699-709. doi: 10.1007/s10461-015-1142-7.

Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings.

Author information

1
Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. jmagidson@mgh.harvard.edu.
2
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
3
Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
4
Harvard School of Public Health, Boston, MA, USA.
5
The Fenway Institute, Fenway Health, Boston, MA, USA.
6
FHI360, Durham, NC, USA.
7
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
8
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
9
Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.
10
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
11
University of Washington, Seattle, WA, USA.
12
Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
13
National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.
14
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
15
Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.
16
Department of Psychology, University of Miami, Coral Gables, FL, USA.

Abstract

Successful biomedical prevention/treatment-as-prevention (TasP) requires identifying individuals at greatest risk for transmitting HIV, including those with antiretroviral therapy (ART) nonadherence and/or 'amplified HIV transmission risk,' defined as condomless sex with HIV-uninfected/unknown-status partners when infectious (i.e., with detectable viremia or STI diagnosis according to Swiss criteria for infectiousness). This study recruited sexually-active, HIV-infected patients in Brazil, Thailand, and Zambia to examine correlates of ART nonadherence and 'amplified HIV transmission risk'. Lower alcohol use (OR = .71, p < .01) and higher health-related quality of life (OR = 1.10, p < .01) were associated with greater odds of ART adherence over and above region. Of those with viral load data available (in Brazil and Thailand only), 40 % met Swiss criteria for infectiousness, and 29 % had 'amplified HIV transmission risk.' MSM had almost three-fold (OR = 2.89, p < .001) increased odds of 'amplified HIV transmission risk' (vs. heterosexual men) over and above region. TasP efforts should consider psychosocial and contextual needs, particularly among MSM with detectable viremia.

KEYWORDS:

Adherence; Alcohol use; Amplified risk; Biomedical prevention; HIV transmission; MSM; Treatment as prevention

PMID:
26246068
PMCID:
PMC4744579
DOI:
10.1007/s10461-015-1142-7
[Indexed for MEDLINE]
Free PMC Article

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