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AIDS and Behavior
Published in: AIDS and Behavior 8/2011

01-11-2011 | Original Paper

Sticking to It: The Effect of Maximally Assisted Therapy on Antiretroviral Treatment Adherence Among Individuals Living with HIV Who are Unstably Housed

Authors: Surita Parashar, Alexis K. Palmer, Nadia O’Brien, Keith Chan, Anya Shen, Suzy Coulter, Julio S. G. Montaner, Robert S. Hogg

Published in: AIDS and Behavior | Issue 8/2011

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Abstract

Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72–13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.
Literature
1.
Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11(6):101–15.PubMedCrossRef
2.
Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99(Suppl 3):S675–80.PubMedCrossRef
3.
Stewart K, Cianfrini L, Walker J. Stress, social support and housing are related to health status among HIV-positive persons in the Deep South of the United States. AIDS Care. 2005;17(3):350–8.PubMedCrossRef
4.
Wolitski RJ, Kidder DP, Pals SL, Royal S, Aidala A, Stall R, et al. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behav. 2010;14(3):493–503.PubMedCrossRef
5.
Hall CS, Charlebois ED, Hahn JA, Moss AR, Bangsberg DR. Hepatitis C virus infection in San Francisco’s HIV-infected urban poor. J Gen Intern Med. 2004;19(4):357–65.PubMedCrossRef
6.
Braitstein P, Montessori V, Chan K, Montaner J, Schechter M, O’Shaughnessy M, et al. Quality of life, depression and fatigue among persons co-infected with HIV and hepatitis C: outcomes from a population-based cohort. AIDS Care. 2005;17(4):505–15.PubMedCrossRef
7.
Lieb S, Brooks RG, Hopkins RS, Thompson D, Crockett LK, Liberti T, et al. Predicting death from HIV/AIDS: a case-control study from Florida public HIV/AIDS clinics. J Acquir Immune Defic Syndr. 2002;30(3):351–8.PubMed
8.
Schwarcz SK, Hsu LC, Vittinghoff E, Vu A, Bamberger JD, Katz MH. Impact of housing on the survival of persons with AIDS. BMC Public Health. 2009;9:220.PubMedCrossRef
9.
Walley AY, Cheng DM, Libman H, Nunes D, Horsburgh CR Jr, Saitz R, et al. Recent drug use, homelessness and increased short-term mortality in HIV-infected persons with alcohol problems. AIDS. 2008;22(3):415.PubMedCrossRef
10.
Kidder D, Wolitski R, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave D. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav. 2007;11:S149–61.CrossRef
11.
Kim TW, Kertesz SG, Horton NJ, Tibbetts N, Samet JH. Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Serv Res. 2006;6:19.PubMedCrossRef
12.
Smith MY, Rapkin BD, Winkel G, Springer C, Chhabra R, Feldman IS. Housing status and health care service utilization among low-income persons with HIV/AIDS. J Gen Intern Med. 2000;15(10):731–8.PubMedCrossRef
13.
Celentano DD, Vlahov D, Cohn S, Shadle VM, Obasanjo O, Moore RD. Self-reported antiretroviral therapy in injection drug users. J Am Med Assoc. 1998;280(6):544–6.CrossRef
14.
Bamberger JD, Unick J, Klein P, Fraser M, Chesney M, Katz MH. Helping the urban poor stay with antiretroviral HIV drug therapy. Am J Public Health. 2000;90(5):699–701.PubMedCrossRef
15.
Paterson DL, Swindells S, Mohr J. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30.PubMed
16.
Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.PubMedCrossRef
17.
Porter K, Babiker A, Bhaskaran K, Darbyshire J, Pezzotti P, Walker AS. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet. 2003;362(9392):1267–74.PubMedCrossRef
18.
Royal SW, Kidder DP, Patrabansh S, Wolitski RJ, Holtgrave DR, Aidala A, et al. Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV. AIDS Care. 2009;21(4):448–55.PubMedCrossRef
19.
Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43:939–41.PubMedCrossRef
20.
Cunningham CO, Sohler NL, Wong MD, Relf M, Cunningham WE, Drainoni ML, et al. Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care STDS. 2007;21(3):177–86.PubMedCrossRef
21.
Pulvirenti JJ, Glowacki R, Muppiddi U, Surapaneni N, Gail C, Kohl B, et al. Hospitalized HIV-infected patients in the HAART era: a view from the inner city. AIDS Patient Care STDS. 2003;17(11):565–73.PubMedCrossRef
22.
Roberts K, Volberding P. Adherence communication: a qualitative analysis of physician-patient dialogue. AIDS. 1999;13:1771–8.PubMedCrossRef
23.
Shapiro MF, Morton SC, McCaffrey DE, Senterfitt JW, Fleishman JA, Perlman JF. Variations in the care of HIV-infected adults in the United States. Results from the HIV cost and services utilization study. J Am Med Assoc. 1999;281(24):2305–15.CrossRef
24.
Wong MD, Cunningham WE, Shapiro MF, et al. Disparities in HIV treatment and physician attitudes about delaying protease inhibitors for nonadherent patients. J Gen Intern Med. 2004;19:366–74.PubMedCrossRef
25.
Bangsberg D, Tulsky JP, Hecht FM, Moss AR. Protease inhibitors in the homeless. J Am Med Assoc. 1997;278:63–5.CrossRef
26.
Berg KM, Demas PA, Howard AA, Schoenbaum EE, Gourevitch MN, Arnsten JH. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Inter Med. 2004;19(11):1111–7.CrossRef
27.
Carballo E, Cadarso-Suarez C, Carrera I, Fraga J, de la Fuente J, Ocampo A, et al. Assessing relationships between health-related quality of life and adherence to antiretroviral therapy. Qual Life Res. 2004;13(3):587–99.PubMedCrossRef
28.
Johnson MO, Catz SL, Remien RH, Rotheram-Borus M, Morin SF, Charlebois E, et al. Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: findings from the healthy living project. AIDS Patient Care STDs. 2003;17(12):645–56.PubMedCrossRef
29.
Spire B, Duran S, Souville M, Leport C, Raffi F, Moatti J. Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. Soc Sci Med. 2002;54(10):1481–96.PubMedCrossRef
30.
Wolitski RJ, Kidder DP, Fenton KA. HIV, homelessness, and public health: critical issues and a call for increased action. AIDS Behav. 2007;11(6):167–71.PubMedCrossRef
31.
Parruti G, Manzoli L, Toro PM, D’amico G, Rotolo S, Graziani V, et al. Long-term adherence to first-line highly active antiretroviral therapy in a hospital-based cohort: predictors and impact on virologic response and relapse. AIDS Patient Care STDs. 2006;20(1):48–56.PubMedCrossRef
32.
Boyer A, Indyk D. Shaping garments of care tools for maximizing adherence potential. Social Work Health Care. 2005;42(3):151–66.CrossRef
33.
Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAiliffe TL. Patterns, correlates and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19:124–33.PubMedCrossRef
34.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.PubMedCrossRef
35.
Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13:1763–9.PubMedCrossRef
36.
Moss AR, Hahn JA, Perry S, et al. Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study. Clin Infect Dis. 2004;39:1190–8.PubMedCrossRef
37.
Nilsson Schonnesson L, Diamond PM, Ross MW, Williams M, Bratt G. Baseline predictors of three types of antiretroviral therapy (ART) adherence: a 2-year follow-up. AIDS Care. 2006;18:407–14.PubMedCrossRef
38.
Riley ED, Wu AW, Perry S, et al. Depression and drug use impact health status among marginally housed HIV-infected individuals. AIDS Patient Care STDS. 2003;17:401–6.PubMedCrossRef
39.
Starace F, Ammassari A, Trotta MP. Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:S136–9.PubMedCrossRef
40.
Waldrop-Valverde D, Valverde E. Homelessness and psychological distress as contributors to antiretroviral nonadherence in HIV-positive injecting drug users. AIDS Patient Care STDS. 2005;19:326–34.PubMedCrossRef
41.
Wood E, Kerr T, Palepu A, Zhang R, Strathdee SA, Tyndall MW, et al. Slower uptake of HIV antiretroviral therapy among Aboriginal injection drug users. J Infect. 2006;52(4):233–6.PubMedCrossRef
42.
Knowlton A, Arnsten J, Eldred L, Wilkinson J, Gourevitch M, Shade S. Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users. J Acquir Immune Defic Syndr. 2006;41:486–92.PubMedCrossRef
43.
Tyndall MW, McNally M, Lai C, Zhang R, Wood E, Kerr T, et al. Directly observed therapy programmes for anti-retroviral treatment amongst injection drug users in Vancouver: access, adherence and outcomes. Int J Drug Policy. 2007;18(4):281–7.PubMedCrossRef
44.
Altice FL, Mezger JA, Hodges J, Bruce RD, Marinovich A, Walton M, et al. Developing a directly administered antiretroviral therapy intervention for HIV-infected drug users: implications for program replication. Clin Infect Dis. 2004;38(Suppl 5):S376–87.PubMedCrossRef
45.
Conway B, Prasad J, Reynolds R, Farley J, Jones M, Jutha S, et al. Directly observed therapy for the management of HIV-infected patients in a methadone program. Clin Infect Dis. 2004;38(Suppl 5):S402–8.PubMedCrossRef
46.
Bangsberg DR, Mundy LM, Tulsky JP. Expanding directly observed therapy: tuberculosis to human immunodeficiency virus. Am J Med. 2001;110(8):664–6.PubMedCrossRef
47.
McCance-Katz EF, Gourevitch MN, Arnsten J, Sarlo J, Rainey P, Jatlow P. Modified directly observed therapy (MDOT) for injection drug users with HIV disease. Am J Addict. 2002;11(4):271–8.PubMedCrossRef
48.
Maru DS, Bruce RD, Walton M, Mezger JA, Springer SA, Shield D, et al. Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Behav. 2008;12(2):284–93.PubMedCrossRef
49.
Mitchell CG, Freels S, Creticos CM, Oltean A, Douglas R. Preliminary findings of an intervention integrating modified directly observed therapy and risk reduction counseling. AIDS Care. 2007;19(4):561–4.PubMedCrossRef
50.
Macalino GE, Hogan JW, Mitty JA, Bazerman LB, Delong AK, Loewenthal H, et al. A randomized clinical trial of community-based directly observed therapy as an adherence intervention for HAART among substance users. AIDS. 2007;21(11):1473–7.PubMedCrossRef
51.
Altice FL, Maru DS, Bruce RD, Springer SA, Friedland GH. Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clin Infect Dis. 2007;45(6):770–8.PubMedCrossRef
52.
53.
54.
Thompson MA, Aberg JA, Cahn P, Montaner JSG, Rizzardini G, Telenti A, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. JAMA. 2010;304(3):321.PubMedCrossRef
55.
56.
Racey CS, Zhang W, Brandson EK, Fernandes KA, Tzemis D, Harrigan PR, et al. HIV antiviral drug resistance: patient comprehension. AIDS Care. 2010;22(7):816–26.PubMedCrossRef
57.
Wood E, Montaner J, Yip B. Adherence and plasma HIV RNA responses to highly active anti-retroviral therapy among HIV-1 infected injection drug users. Can Med Assoc J. 2003;169:656–61.
58.
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50(1):105–16.PubMedCrossRef
59.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.PubMed
60.
Kendall A, Olson CM, Frongillo EA Jr. Validation of the Radimer/Cornell measures of hunger and food insecurity. J Nutr. 1995;125(11):2793–801.PubMed
61.
Radimer KL, Olson CM, Campbell CC. Development of indicators to assess hunger. J Nutr. 1990;120(11_Suppl):1544–8.PubMed
62.
63.
SAS Institute. SAS/STAT user’s guide: Version 9.1.3, Version 9. Cary: SAS Institute; 2008.
64.
Joy R, Druyts EF, Brandson EK, Lima VD, Rustad CA, Zhang W, et al. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. J Acquir Immune Defic Syndr. 2008;47(4):500–5.PubMedCrossRef
65.
Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS, et al. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280(6):547–9.PubMedCrossRef
66.
Conover CJ, Whetten-Goldstein K. The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage. AIDS Care. 2002;14(Suppl 1):S59–71.PubMedCrossRef
67.
Bica I, Tang AM, Skinner S, Spiegelman D, Knox T, Gorbach S, et al. Use of complementary and alternative therapies by patients with human immunodeficiency virus disease in the era of highly active antiretroviral therapy. J Altern Complement Med. 2003;9(1):65–76.PubMedCrossRef
68.
Dasinger LK, Speiglman R. Homelessness prevention: the effect of a shallow rent subsidy program on housing outcomes among people with HIV or AIDS. AIDS Behav. 2007;11(6):128–39.PubMedCrossRef
69.
Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6):85–100.PubMedCrossRef
70.
71.
Shubert V, Bernstine N. Moving from fact to policy: housing is HIV prevention and health care. AIDS Behav. 2007;11(6):172–81.PubMedCrossRef
72.
73.
74.
Wohl AR, Garland WH, Valencia R, Squires K, Witt MD, Kovacs A, et al. A randomized trial of directly administered antiretroviral therapy and adherence case management intervention. Clin Infect Dis. 2006;42(11):1619–27.PubMedCrossRef
Metadata
Title
Sticking to It: The Effect of Maximally Assisted Therapy on Antiretroviral Treatment Adherence Among Individuals Living with HIV Who are Unstably Housed
Authors
Surita Parashar
Alexis K. Palmer
Nadia O’Brien
Keith Chan
Anya Shen
Suzy Coulter
Julio S. G. Montaner
Robert S. Hogg
Publication date
01-11-2011
Publisher
Springer US
Published in
AIDS and Behavior / Issue 8/2011
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-011-0026-8

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