Anita C Benoit1,2, Ann N Burchell2,3, Kelly K O'Brien4,5,6, Janet Raboud2,7, Sandra Gardner2,8, Lucia Light9, Kerrigan Beaver1, Jasmine Cotnam1, Tracey Conway10, Colleen Price10, Sean B Rourke11,12, Sergio Rueda12,13, Trevor A Hart2,14, Mona Loutfy1,5,15,16. 1. Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 3. Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 4. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. 5. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 6. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. 7. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 8. Baycrest Health Sciences, Kunin-Lunenfeld Centre for Applied Research and Evaluation (KL-CARE), Toronto, ON, Canada. 9. Ontario HIV Treatment Network, Toronto, ON, Canada. 10. Project Community Advisory Committee, Ontario HIV Treatment Network Cohort Study, Ontario, Canada. 11. Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada. 12. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 13. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada. 14. Department of Psychology, Ryerson University, Toronto, ON, Canada. 15. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 16. Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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.
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.
Entities:
Keywords:
HIV; Stress; antiretroviral therapy; depression; women