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Perri M, Hapsari AP, Craig-Neil A, Ho J, Cattaneo J, Gaspar M, Hunter C, Rueda S, Burchell AN, Pinto AD. An evaluation of an employment assistance program focused on people living with HIV in Toronto, Canada. AIDS Care 2024; 36:500-507. [PMID: 37756653 DOI: 10.1080/09540121.2023.2253505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Unemployment is more common among people living with HIV (PLWH) compared to the general population. PLWH who are employed have better physical and mental health outcomes compared to unemployed PLWH. The main objective of this mixed-methods study was to conduct a program evaluation of Employment Action (EACT), a community-based program that assists PLWH in Toronto, Ontario, Canada to maintain meaningful employment. We extracted quantitative data from two HIV services databases used by EACT, and collected qualitative data from 12 individuals who had been placed into paid employment through EACT. From 131 clients included in the analysis, 38.1% (n = 50) maintained their job for at least 6 weeks within the first year of enrollment in the EACT program. Gender, ethnicity, age, and first language did not predict employment maintenance. Our interviews highlighted the barriers and facilitators to effective service delivery. Key recommendations include implementing skills training, embedding PLWH as EACT staff, and following up with clients once they gain employment. Investment in social programs such as EACT are essential for strengthening their data collection capacity, active outreach to service users, and sufficient planning for the evaluation phase prior to program implementation.
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Affiliation(s)
- Melissa Perri
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ayu Pinky Hapsari
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Julia Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | | | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Charlotte Hunter
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Angel JB, Freilich J, Arthurs E, Ban JK, Lachaine J, Chounta V, Harris M. Adherence to oral antiretroviral therapy in Canada, 2010-2020. AIDS 2023; 37:2031-2040. [PMID: 37418513 PMCID: PMC10552836 DOI: 10.1097/qad.0000000000003648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To assess antiretroviral therapy (ART) adherence among people with HIV (PWH) in Canada and identify baseline characteristics associated with suboptimal adherence (<95%). DESIGN Retrospective observational study using data from the National Prescription Drug Utilization Information System and Régie de l'assurance maladie Quebec (RAMQ) Public Prescription Drug Insurance Plan. METHODS This analysis included PWH aged 18 years or older who initiated an ART regimen and were followed for at least 12 months (2010-2020). Patient characteristics were summarized using medical/pharmacy claims data from seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). ART regimen at index date (first dispensing of a regimen including a core agent) was defined as a single-tablet or multitablet regimen (MTR). Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Multivariate linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics. RESULTS We identified 19 322 eligible PWH, 44.7% of whom had suboptimal adherence (<95%). Among 12 594 PWH with evaluable baseline data, 10 673 (84.8%) were ART-naive, 74.2% were men, mean age was 42.9 years, and 54.1% received a MTR as their ART. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multitablet ART ( P < 0.001) and younger age ( P < 0.001) but not sex. CONCLUSION Almost half of adult PWH in Canada had suboptimal adherence to ART. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact adherence.
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Affiliation(s)
- Jonathan B. Angel
- Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, Ontario, Canada
| | - Jonatan Freilich
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå
- Parexel International, Stockholm, Sweden
| | - Erin Arthurs
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Joann K. Ban
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Jean Lachaine
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Vasiliki Chounta
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, UK
| | - Marianne Harris
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Odhiambo AJ, O'Campo P, Nelson LRE, Forman L, Grace D. Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography. Int J Equity Health 2023; 22:33. [PMID: 36797746 PMCID: PMC9935247 DOI: 10.1186/s12939-022-01792-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 02/18/2023] Open
Abstract
Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of 'structural violence' to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada's social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered "bad" patients while privileged individuals who achieve undetectability are considered "good" patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.
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Affiliation(s)
- Apondi J Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - La Ron E Nelson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
- Yale School of Nursing, New Haven, CT, USA
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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4
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Medeiros P, Warren L, Kazemi M, Massaquoi N, Smith S, Tharao W, Serghides L, Logie CH, Kroch A, Burchell AN, de Pokomandy A, Kaida A, Loutfy M, On behalf of the CHIWOS Research Team. HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada. Int J STD AIDS 2023; 34:4-17. [PMID: 36411243 PMCID: PMC9806481 DOI: 10.1177/09564624221108034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Greater Toronto Area (GTA) is home to 39% of Canada's population living with HIV. To identify gaps in access and engagement in care and treatment, we assessed the care cascade of women living with HIV (WLWH) in the GTA versus the rest of Ontario and Canada (in this case: Quebec and British Columbia). METHODS We analyzed 2013-2015 self-reported baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study for six care cascade stages: linked to care, retained in care, initiated antiretroviral therapy (ART), currently on ART, ART adherence (≥90%), and undetectable (<50 copies/mL). Multivariable logistic regression was used to reveal associations with being undetectable. RESULTS Comparing the GTA to the rest of Ontario and Canada, respectively: 96%, 98%, 100% were linked to care; 92%, 94%, 98% retained in care; 72%, 89%, 96% initiated ART; 67%, 81%, 90% were currently using ART; 53%, 66%, 77% were adherent; 59%, 69%, 81% were undetectable. Factors associated with viral suppression in the multivariable model included: living outside of the GTA (Ontario: aOR = 1.72, 95% CI: 1.09-2.72; Canada: aOR = 2.42, 95% CI: 1.62-3.62), non-Canadian citizenship (landed immigrant/permanent resident: aOR = 3.23, 95% CI: 1.66-6.26; refugee/protected person/other status: aOR = 4.77, 95% CI: 1.96-11.64), completed high school (aOR = 1.77, 95% CI: 1.15-2.73), stable housing (aOR = 2.13, 95% CI: 1.33-3.39), income of ≥$20,000 (aOR = 1.52, 95% CI: 1.00-2.31), HIV diagnosis <6 years (6-14 years: aOR = 1.75, 95% CI: 1.16-2.63; >14 years: aOR = 1.87, 95% CI: 1.19-2.96), and higher resilience (aOR = 1.02, 95% CI: 1.00-1.04). CONCLUSION WLWH living in the GTA had lower rates of viral suppression compared to the rest of Ontario and Canada even after adjustment of age, ethnicity, and HIV diagnosis duration. High-impact programming for WLWH in the GTA to improve HIV outcomes are greatly needed.
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Affiliation(s)
- Priscilla Medeiros
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Priscilla Medeiros, PhD, Women’s College
Research Institute, Women’s College Hospital, 76 Grenville Street, Room 6415,
Toronto, ON M5G 1N8, Canada. E-mail:
| | - Laura Warren
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mina Kazemi
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | | | - Stephanie Smith
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada
| | - Wangari Tharao
- Women’s Health in Women’s Hands
Community Health, Toronto, ON, Canada
| | - Lena Serghides
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Toronto General Hospital Research
Institute, University Health
Network, Toronto, ON, Canada,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Ann N Burchell
- Department of Family and Community
Medicine, St. Michael’s Hospital, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health
Centre, Montreal, QC, Canada,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College
Hospital, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Logie CH, Sokolovic N, Kazemi M, Islam S, Frank P, Gormley R, Kaida A, de Pokomandy A, Loutfy M. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J Int AIDS Soc 2022; 25 Suppl 1:e25913. [PMID: 35818863 PMCID: PMC9274209 DOI: 10.1002/jia2.25913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Nina Sokolovic
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Odhiambo AJ, Forman L, Nelson LE, O'Campo P, Grace D. Unmasking legislative constraints: An institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and Black people in Ontario, Canada. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000714. [PMID: 36962554 PMCID: PMC10021522 DOI: 10.1371/journal.pgph.0000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic significantly impacts African, Caribbean, and Black (ACB) immigrants in Canada. Health scholarship has revealed striking injustices within Canada's public healthcare system that restrict access to healthcare and violate the human rights of ACB immigrants living with HIV who are marginalized. We conducted an institutional ethnography to comprehensively understand how HIV healthcare in Ontario is organized and experienced by ACB immigrants, focusing on unjust and discriminatory legislative frameworks and institutional practices regulating access to publicly funded healthcare resources and services. We interviewed 20 ACB immigrants and 15 healthcare workers, including specialists, primary care providers, immigration physicians, and social workers. We found a disjuncture between the organization of HIV healthcare in Ontario and how ACB immigrants experienced access to care. We uncovered how immigration, public health and healthcare laws and related institutional practices intersect to produce structural violence which create barriers and missed opportunities to timely linkage and engagement in HIV healthcare. Black immigrants' accounts revealed that they underwent mandatory HIV under the Immigration Medical Examination policy (IME) without providing informed consent and receiving pre and post-test counselling. Furthermore, Black immigrants did not receive referrals and were not adequately linked to care following HIV diagnosis. Troubling encounters with immigration and public health state agents and healthcare legislative barriers including difficulty finding a physician, the 3-month waiting period under the Ontario Health Insurance Plan (OHIP), long wait times, lack of drug coverage, and stigma, discrimination, and anti-Black racism shaped and affected Black people's linkage and engagement in HIV care. We elucidate how the legislative and structural organization of healthcare regulated and constrained health service access for ACB immigrants living with HIV, including their ability to "achieve" HIV undetectability.
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Affiliation(s)
- Apondi J Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - LaRon E Nelson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Yale School of Nursing, New Haven, Connecticut, United States of America
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rachlis B, Nam S, Rosenes R, Santoni T, Peck R, Betts A, Kendall C, Yoong D, Sharp A, Gauvin H, Goddard L, Owino M, Rourke SB, Antoniou T. Using concept mapping to explore the challenges associated with affording and accessing medications among people living with HIV in Ontario, Canada. AIDS Care 2020; 33:827-832. [PMID: 32490685 DOI: 10.1080/09540121.2020.1770182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antiretroviral medications are expensive, and people living with HIV often experience challenges accessing and paying for medication due to various obstacles. We used concept mapping to explore the challenges people living with HIV in Ontario, Canada, face when accessing medication. In brainstorming, 68 participants generated 447 statements in response to the focus prompt "Some people living with HIV have trouble getting and paying for prescription drugs because … ". These were consolidated into 77 statements, which were sorted (n = 30) and rated (n = 32) on importance and commonality. A ten-cluster concept map consisting of individual- and health system-related clusters was generated. Clusters included: (1) Stigma, (2) Medication-Related Issues, (3) Individual Challenges, (4) Basic Needs, (5) Immigration, (6) Coverage, (7) Trillium Drug Program, (8) Access to Services, (9) System-Level Issues and (10) Access to Professional Services. Statements in Coverage and Basic Needs were rated most important and common although there was variability by Ontario residence and drug coverage mechanisms. Strategies to address challenges were generated in Interpretation (n = 25 participants). Given that continuous access to antiretroviral therapy is necessary to fully realize treatment benefits, policies and interventions that address these challenges are needed.
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Affiliation(s)
- Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Seungwon Nam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV/AIDS Legal Network, Toronto, Canada
| | | | - Ryan Peck
- HIV & AIDS Legal Clinic Ontario (HALCO), Toronto, Canada
| | - Adrian Betts
- The AIDS Committee of Durham Region, Oshawa, Canada
| | - Claire Kendall
- Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Deborah Yoong
- Department of Pharmacy, St. Michael's Hospital, Toronto, Canada
| | | | | | | | - Maureen Owino
- Committee for Accessible AIDS Treatment (CAAT), Toronto, Canada
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
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- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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8
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Benoit AC, Burchell AN, O'Brien KK, Raboud J, Gardner S, Light L, Beaver K, Cotnam J, Conway T, Price C, Rourke SB, Rueda S, Hart TA, Loutfy M. Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario. HIV Res Clin Pract 2020; 21:45-55. [PMID: 32419657 DOI: 10.1080/25787489.2020.1763711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to identify the association between stress and antiretroviral therapy (ART) adherence among women in HIV care in Toronto, Ontario participating in the Ontario HIV Treatment Network Cohort Study (OCS) between 2007 and 2012. MATERIALS AND METHODS We conducted cross-sectional analyses with women on ART completing the AIDS Clinical Trial Group (ACTG) Adherence Questionnaire. Data closest to, or at the last completed interview, were collected from medical charts, through record linkage with Public Health Ontario Laboratories, and from a standardized self-reported questionnaire comprised of socio-demographic and psycho-socio-behavioral measures (Center for Epidemiologic Studies Depression Scale (CES-D), Alcohol Use Disorders Identification Test (AUDIT)), and stress measures (National Population Health Survey). Logistic regression was used to quantify associations with optimal adherence (≥95% adherence defined as missing ≤ one dose of ART in the past 4 weeks). RESULTS Among 307 women, 65.5% had optimal adherence. Women with suboptimal compared to optimal adherence had higher median total stress scores (6.0 [interquartile range (IQR): 3.0-8.1] vs. 4.1 [IQR: 2.0-7.1], p = 0.001), CES-D scores (16 [IQR: 6-28] vs. 12 [IQR: 3-22], p = 0.008) and reports of hazardous and harmful alcohol use (31.1% vs. 17.9%, p = 0.008). In our multivariable model, we found an increased likelihood of optimal adherence with the absence of hazardous and harmful alcohol use (Adjusted Odds Ratio (AOR)=2.20, 95% confidence interval (CI): 1.12-4.32) and a decreased likelihood of optimal adherence with more self-reported stress (AOR = 0.56, 95% CI: 0.33-0.94). CONCLUSIONS Interventions supporting optimal ART adherence should address stress and include strategies to reduce or eliminate hazardous and harmful alcohol use for women living with HIV.
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Affiliation(s)
- Anita C Benoit
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Baycrest Health Sciences, Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Toronto, ON, Canada
| | - Lucia Light
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Kerrigan Beaver
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jasmine Cotnam
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tracey Conway
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Colleen Price
- Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sergio Rueda
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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