Dataset Information

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam.

ABSTRACT:

Background

The burden of depression is high among people who inject drugs (PWID) and may contribute to the spread of HIV through poor treatment engagement and persistent viremia. We estimated the effects of depression on antiretroviral therapy (ART) initiation and viral suppression among PWID living with HIV.

Methods

Longitudinal data were collected from 455 PWID living with HIV in Vietnam during 2009-2013. We estimated the 6- and 12-month cumulative incidence of ART initiation and viral suppression, accounting for time-varying confounding, competing events, and missing data. The cumulative incidence difference (CID) contrasted the incidence of each outcome had participants always vs. never experienced severe depressive symptoms across study visits to date.

Results

Severe depressive symptoms decreased the cumulative incidence of ART initiation, with CID values comparing always vs. never having severe depressive symptoms of -7.5 percentage points (95% CI: -17.2, 2.2) at 6 months and -7.1 (95% CI: -17.9, 3.7) at 12 months. There was no appreciable difference in the cumulative incidence of viral suppression at 6 months (CID = 0.3, 95% CI: -11.3, 11.9) or 12 months (CID = 2.0, 95% CI: -21.8, 25.8).

Limitations

Discrepancies between the ART initiation and viral suppression outcomes could be due to under-reporting of ART use and missing data on viral load.

Conclusions

Future work probing the seemingly antagonistic effect of depression on treatment uptake - but not viral suppression - will inform the design of interventions promoting HIV clinical outcomes and reducing onward transmission among PWID.

SUBMITTER: Levintow SN

PROVIDER: S-EPMC7855445 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam.

Levintow Sara N SN Pence Brian W BW Powers Kimberly A KA Breskin Alexander A Sripaipan Teerada T Ha Tran Viet TV Chu Viet Anh VA Quan Vu Minh VM Latkin Carl A CA Go Vivian F VF

Journal of affective disorders 20201209

<h4>Background</h4>The burden of depression is high among people who inject drugs (PWID) and may contribute to the spread of HIV through poor treatment engagement and persistent viremia. We estimated the effects of depression on antiretroviral therapy (ART) initiation and viral suppression among PWID living with HIV.<h4>Methods</h4>Longitudinal data were collected from 455 PWID living with HIV in Vietnam during 2009-2013. We estimated the 6- and 12-month cumulative incidence of ART initiation an ...[more]

PMID: 33333474

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Project description:IntroductionIncreasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID.MethodsProspective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART.ResultsOverall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001).ConclusionsDespite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care.Trial registrationClinical Trial Number: NCT03249493.

Dataset Information

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam.

Background

Methods

Results

Limitations

Conclusions

Publications

Depression, antiretroviral therapy initiation, and HIV viral suppression among people who inject drugs in Vietnam.

Similar Datasets

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