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Anti-Retroviral Therapy Adherence Among People Who Inject Drugs and Their Partners in Kazakhstan
Neueschwander, Paige
Neueschwander, Paige
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Afable, Aimee, Thompson, Azure, Davis, Alissa
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2024-12-06
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Background: This dissertation addresses the critical public health issue of antiretroviral therapy (ART) adherence among people with HIV (PWH) who inject drugs (PWID) in Kazakhstan, a country experiencing one of the world's fastest-growing HIV epidemics. The research examines factors influencing ART adherence among PWID, with a particular focus on the impact of the COVID-19 pandemic. The central research questions explored are: "What multi-level factors are associated with ART adherence among PWID with HIV in serococordant and serodiscordant relationships?” and "What factors are associated with ART adherence among HIV-positive PWID during the COVID-19 pandemic?”
Methods: This study investigated HIV medication adherence among people who inject drugs (PWID) using two complementary methodological approaches. First, qualitative analysis used in-depth interviews with 20 PWID living with HIV and 18 of their intimate partners, analyzing the dyadic data to understand relationship dynamics and shared experiences around medication adherence. Building on these qualitative insights, we then conducted a secondary-data analysis on a cross-sectional survey from October 2020 to August 2022 with 66 HIV-positive PWID and their treatment support partners (n=66). The survey data were analyzed using multilevel generalized linear mixed models with Bayesian estimation to examine factors associated with ≥90% and ≥80% adherence levels. The qualitative findings informed our selection of variables for the quantitative analysis and provided contextual depth to interpret the statistical results.
Results: Qualitative results revealed multilevel barriers and facilitators of ART adherence at individual (e.g., substance use), interpersonal (e.g., social support), and structural levels (e.g., stigma, transportation). The manifestation of social support varied between seroconcordant and serodiscordant dyads. Quantitative findings showed low overall ART adherence, with 55.8% of participants achieving ≥80% adherence and only 14.7% reaching the ≥90% threshold. Key factors associated with higher adherence included: having a partner with HIV (AOR=14.94, 95% CI=1.51-420.77) for ≥90% adherence; lower conflict at home during the COVID-19 pandemic (AOR=22.77, 95% CI=1.62-841.84) for ≥90% adherence; and meeting with a professional to discuss alcohol or drug use (AOR=6.78, 95% CI=1.25-117.61) for ≥80% adherence. Factors associated with lower adherence included: poorer mental health (AOR=0.09, 95% CI=0.005, 0.76) for ≥80% adherence and experiencing negative emotional impacts of COVID-19 (AOR=0.18, 95% CI=0.002, 0.98) for ≥80% adherence.
Conclusion: This dissertation concludes that relationship factors, social support, partner HIV status, mental health, and the personal impact of public health crises significantly influence ART adherence among PWID. These findings have important implications for public health policy and clinical practice in addressing the HIV epidemic in Kazakhstan and similar contexts, particularly during periods of mass disruption like the COVID-19 pandemic. Future research and interventions may benefit from integrating dyad approaches into ART adherence strategies, considering partner HIV status, prioritizing mental health support, and addressing the personal and household impacts of crises. Such comprehensive approaches could potentially improve health outcomes for PWH and reduce HIV transmission risk among PWID populations.
Citation
Neuenschwander, P. (2024) Anti-Retroviral Therapy Adherence Among People Who Inject Drugs and Their Partners in Kazakhstan. [Doctoral Dissertation, SUNY Downstate Health Sciences University]. SUNY Open Access Repository. https://soar.suny.edu/handle/20.500.12648/16051