Psychosocial Barriers to Viral Suppression in a Community-based Sample of Human Immunodeficiency Virus–infected Men Who Have Sex With Men and People Who Inject Drugs in India
Year: 2019
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)-infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. METHODS: MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. RESULTS: Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI}, .16-.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI, .20-.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI, .09-.57]). Among PWID, daily injection (aPR, 0.51 [95% CI, .31-.82]) was the primary barrier to suppression. CONCLUSIONS: Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciz175
Authors: Sandeep Prabhu, Allison M McFall, Shruti H Mehta, Aylur K Srikrishnan, Muniratnam Suresh Kumar, Santhanam Anand, Saravanan Shanmugam, David D Celentano, Gregory M Lucas, Sunil S Solomon
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: Investigating the Potential of Respondent-Driven Sampling to Reach Undiagnosed, Out-of-Care HIV-infected People Who Inject Drugs, G2716633124, G3761414582, G853952710, G9000006214, G9000053707, G9000061149, G9000266004, The Johns Hopkins Center for AIDS Research (JHU CFAR), Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program
OpenAlex ID: W2921090260