Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses.
Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses.
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DOI：
10.1016/s2468-2667(16)30002-0
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Lampe FC
中科院分区：
文献类型：
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作者：
Burch LS;Smith CJ;Anderson J;Sherr L;Rodger AJ;O'Connell R;Geretti AM;Gilson R;Fisher M;Elford J;Jones M;Collins S;Azad Y;Phillips AN;Speakman A;Johnson MA;Lampe FC
很少有研究评估了社会经济地位对艾滋病毒治疗结果的影响，在普遍获得医疗保健的情况下。在这里，我们的目的是调查社会经济因素与抗逆转录病毒治疗（ART）的非依从性，病毒学非抑制，和病毒学反弹，在艾滋病毒阳性的人在英国的抗逆转录病毒治疗。我们使用了来自抗逆转录病毒药物、性传播风险和态度（ASTRA）问卷调查研究的数据，该研究招募了2011年2月1日至2012年12月31日期间来自英国8家HIV门诊诊所的18岁或以上的HIV感染者。参与者自我完成了一份关于社会人口统计学，健康和生活方式问题的保密问卷。在接受抗逆转录病毒治疗的参与者中，我们评估了经济困难、就业、住房和教育与以下因素的关系：问卷调查时自我报告的抗逆转录病毒治疗不依从性;病毒学不抑制;（病毒载量>50拷贝/mL）在至少6个月前开始ART的患者中进行问卷调查时（横断面分析）;和随后的病毒学反弹（病毒载量>200拷贝/mL），在那些初始病毒载量为50拷贝/mL或更低（纵向分析）。在完成问卷的3258人中，有2771人（85%）在问卷调查时报告正在接受抗逆转录病毒治疗，其中2704人的数据完整。在横断面分析中，2704名参与者中有873名（32%）报告不依从ART，2405名参与者中有219名（9%）报告病毒学未抑制。社会经济地位较低的四个指标中的每一个都与不坚持抗逆转录病毒治疗和病毒学不抑制密切相关。（经性别/性取向、年龄和种族校正的患病率[PR]：最大经济困难与无经济困难2.4，95%CI 1.6 - 3.4;无工作2.0，1.5 - 2.6;住房不稳定与房主3.0，1.9 - 4.6;非大学教育1·6，1·2-2·2）。1740例患者中有139例（8%）随后出现病毒学反弹（发生率= 3.6/100人-年）。低社会经济地位可预测纵向反弹风险（最大经济困难与无经济困难的校正风险比[HR]为2.3，95% CI 1.4 - 3.9;非就业3.0，2.1 - 4.2;不稳定住房与房主3.3，1.8 - 6.1;非大学教育1.6，1.1 - 2.3）。在这种全民保健的环境中，社会经济劣势与艾滋病毒治疗结果较差密切相关。应考虑对那些风险最大的人进行依从性干预和增加社会支持。国立卫生研究院。
Few studies have assessed the effect of socioeconomic status on HIV treatment outcomes in settings with universal access to health care. Here we aimed to investigate the association of socioeconomic factors with antiretroviral therapy (ART) non-adherence, virological non-suppression, and virological rebound, in HIV-positive people on ART in the UK. We used data from the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. Participants self-completed a confidential questionnaire on sociodemographic, health, and lifestyle issues. In participants on ART, we assessed associations of financial hardship, employment, housing, and education with: self-reported ART non-adherence at the time of the questionnaire; virological non-suppression (viral load >50 copies per mL) at the time of questionnaire in those who started ART at least 6 months ago (cross-sectional analysis); and subsequent virological rebound (viral load >200 copies per mL) in those with initial viral load of 50 copies per mL or lower (longitudinal analysis). Of the 3258 people who completed the questionnaire, 2771 (85%) reported being on ART at the time of the questionnaire, and 2704 with complete data were included. 873 (32%) of 2704 participants reported non-adherence to ART and 219 (9%) of 2405 had virological non-suppression in cross-sectional analysis. Each of the four measures of lower socioeconomic status was strongly associated with non-adherence to ART, and with virological non-suppression (prevalence ratios [PR] adjusted for gender/sexual orientation, age, and ethnic origin: greatest financial hardship vs none 2·4, 95% CI 1·6–3·4; non-employment 2·0, 1·5–2·6; unstable housing vs homeowner 3·0, 1·9–4·6; non-university education 1·6, 1·2–2·2). 139 (8%) of 1740 individuals had subsequent virological rebound (rate=3·6/100 person-years). Low socioeconomic status was predictive of longitudinal rebound risk (adjusted hazard ratio [HR] for greatest financial hardship vs none 2·3, 95% CI 1·4–3·9; non-employment 3·0, 2·1–4·2; unstable housing vs homeowner 3·3, 1·8–6·1; non-university education 1·6, 1·1–2·3). Socioeconomic disadvantage was strongly associated with poorer HIV treatment outcomes in this setting with universal health care. Adherence interventions and increased social support for those most at risk should be considered. National Institute for Health Research.