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Longitudinal Effects of Syndemics on ART Non-adherence Among Sexual Minority Men

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Abstract

This study examined longitudinally the additive effect of syndemics, or co-occurring psychosocial problems, on antiretroviral treatment (ART) non-adherence among 390 HIV-positive sexual minority men. Participants completed measures of ART adherence (reduced to a non-adherence score using exploratory factor analysis) and six syndemic conditions. We employed multilevel modeling with the number of syndemics as a longitudinal predictor of non-adherence, and logistic regression with baseline syndemics predicting follow up viral load. Number of syndemics was a significant longitudinal predictor of non-adherence, with each additional syndemic associated with a 0.13 increase in non-adherence (p = 0.004). Each additional syndemic was also associated with 1.27 greater odds of detectable viral load (p = 0.002). Among HIV-positive sexual minority men in this sample, more syndemics were associated with lower ART adherence and greater odds of detectable viral load, suggesting the need for behavioral intervention to facilitate care for this population.

Resumen

Este estudio examinó longitudinalmente el efecto aditivo de sindémicas, o problemas psicosociales concurrentes, sobre la falta de adherencia al tratamiento antirretroviral (ART por sus siglas en inglés) entre 390 hombres VIH positivos de minorías sexuales. Los participantes completaron medidas de adherencia al ART (reducidas a un puntaje de falta de adherencia usando un análisis factorial exploratorio) y seis condiciones sindémicas. Empleamos el modelado multinivel con el número de sindémicas como un predictor longitudinal de la falta de adherencia, y una regresión logística que predice la carga viral de las visitas de seguimiento usando la cita inicial como referencia. El número de sindémicas fue un predictor longitudinal significativo de la falta de adherencia, con cada sindémica adicional asociada con un aumento de 0.13 en la falta de adherencia (p = 0.004). Cada sindémica adicional también se asoció con 1.27 mayores probabilidades de carga viral detectable (p = 0.002). Entre los hombres VIH-positivos de minorías sexuales en esta muestra, más sindémicas se asociaron con menos adherencia al ART y mayores probabilidades de carga viral detectable, sugiriendo la necesidad de una intervención conductual para facilitar el cuidado de la salud de esta población.

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Notes

  1. A sensitivity test using the log transformed non-adherence factor scores as the outcome variable revealed the same pattern of results as the original model. Syndemics remained a significant predictor of the log transformed non-adherence scores, γ = 0.03, SE = 0.01, t(513) = 0.002. Because the pattern of the results was unchanged, we retained the original factor score distribution with robust standard errors to increase interpretability of the findings.

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Funding

This study was funded in by HRSA (H97HA01293) and NIMH (5R01MH068746) awarded to Drs. Kenneth H. Mayer and Steven A. Safren. Some of the author time was supported by NIDA (9K24DA040489) awarded to Dr. Steven A. Safren.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Clinical Research Building (C-204), 1120 NW 14th Street, Suite 786, Miami, FL, 33136, USA

    Audrey Harkness, Sierra A. Bainter, Noelle A. Mendez & Steven A. Safren

  2. Fenway Community Health, The Fenway Institute, Boston, MA, USA

    Conall O’Cleirigh, Kenneth H. Mayer & Steven A. Safren

  3. Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

    Conall O’Cleirigh

  4. Division of Infectious Disease, Department of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth H. Mayer

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  1. Audrey Harkness
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  2. Sierra A. Bainter
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  3. Conall O’Cleirigh
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  4. Noelle A. Mendez
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  5. Kenneth H. Mayer
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  6. Steven A. Safren
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Correspondence to Audrey Harkness.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Harkness, A., Bainter, S.A., O’Cleirigh, C. et al. Longitudinal Effects of Syndemics on ART Non-adherence Among Sexual Minority Men. AIDS Behav 22, 2564–2574 (2018). https://doi.org/10.1007/s10461-018-2180-8

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