Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men.
Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men.
复制标题
DOI：
10.1186/s12889-020-09883-z
复制
发表时间：
2020-11-25
影响因子：
4.5
通讯作者：
Rehm J
中科院分区：
文献类型：
--
作者：
Shuper PA;Joharchi N;Bogoch II;Loutfy M;Crouzat F;El-Helou P;Knox DC;Woodward K;Rehm J
虽然艾滋病毒暴露前预防（PrEP）大大减少了艾滋病毒收购的可能性，坚持不良可以减少艾滋病毒的保护效益PrEP. The本调查旨在确定在何种程度上饮酒，物质使用和抑郁症与同性恋，双性恋，和其他男人之间的PrEP非坚持性行为（gbMSM）。gbMSM从加拿大多伦多的两个诊所招募了10名（年龄≥ 18岁，处方PrEP ≥3个月）患者，进行电子调查，评估人口统计学; PrEP不依从性（为期4天的以PrEP为重点的ACTG评估）;危险和有害的酒精使用（AUDIT评分分别为8-15和16+）;中度/高度风险物质使用（NIDA M-ASSIST评分> 4）;抑郁（CESD-10评分≥10）;以及其他PrEP相关因素。主要结局是PrEP不依从，在过去4天内缺失一个或多个PrEP剂量。一项线性相关性检验评估了酒精使用严重程度的增加（即，基于AUDIT类别）与PrEP不依从性的发生率更高有关。采用单变量logistic回归确定与PrEP不依从性相关的因素，并将在p < .10显著性水平下显示单变量相关性的因素纳入多变量logistic回归模型。通过逻辑回归评估涉及关键重要因素的加和交互作用，以评估潜在的以症状为中心的关联。共有141 gbMSM（平均年龄= 37.9，白色= 63.1%）完成了电子调查。危险/有害饮酒（31.9%），中度/高风险物质使用（43.3%）和抑郁症（23.7%）是常见的;五分之一的参与者（19.9%）报告PrEP不依从。增加酒精使用水平与更大的不依从可能性显著相关（即，15.6%、25.0%和44.4%的低风险、危险和有害饮酒者报告不依从（χ2（1）= 4.79，p = 0.029）。多变量logistic回归分析表明，有害酒精使用（AOR = 6.72，95%CI = 1.49-30.33，p = 0.013）和中/高危可卡因使用（AOR = 3.11，95%CI = 1.01-9.59，p = 0.049）独立预测不依从性。此外，还出现了一种累加关联，其中危险/有害饮酒者和中度/高度风险可卡因使用者中PrEP不依从的可能性最高（OR = 2.25，95%CI = 1.19-4.25，p = 0.013）。抑郁症与不依从性无关。调查结果强调，需要将酒精和物质为重点的举措纳入gbMSM的PrEP护理。反过来，这些举措可能有助于提高PrEP的依从性，并减少这一群体感染艾滋病毒的可能性。
Although HIV pre-exposure prophylaxis (PrEP) substantially diminishes the likelihood of HIV acquisition, poor adherence can decrease the HIV-protective benefits of PrEP. The present investigation sought to identify the extent to which alcohol consumption, substance use, and depression were linked to PrEP nonadherence among gay, bisexual, and other men-who-have-sex-with-men (gbMSM). gbMSM (age ≥ 18, prescribed PrEP for ≥3 months) were recruited from two clinics in Toronto, Canada for an e-survey assessing demographics; PrEP nonadherence (4-day PrEP-focused ACTG assessment); hazardous and harmful alcohol use (AUDIT scores of 8–15 and 16+, respectively); moderate/high risk substance use (NIDA M-ASSIST scores > 4); depression (CESD-10 scores ≥10); and other PrEP-relevant factors. The primary outcome, PrEP nonadherence, entailed missing one or more PrEP doses over the past 4 days. A linear-by-linear test of association assessed whether increasing severity of alcohol use (i.e., based on AUDIT categories) was linked to a greater occurrence of PrEP nonadherence. Univariate logistic regression was employed to determine factors associated with PrEP nonadherence, and factors demonstrating univariate associations at the p < .10 significance level were included in a multivariate logistic regression model. Additive and interactive effects involving key significant factors were assessed through logistic regression to evaluate potential syndemic-focused associations. A total of 141 gbMSM (Mean age = 37.9, white = 63.1%) completed the e-survey. Hazardous/harmful drinking (31.9%), moderate/high risk substance use (43.3%), and depression (23.7%) were common; and one in five participants (19.9%) reported PrEP nonadherence. Increasing alcohol use level was significantly associated with a greater likelihood of nonadherence (i.e., 15.6, 25.0, and 44.4% of low-risk, hazardous, and harmful drinkers reported nonadherence, respectively (χ2(1) = 4.79, p = .029)). Multivariate logistic regression demonstrated that harmful alcohol use (AOR = 6.72, 95%CI = 1.49–30.33, p = .013) and moderate/high risk cocaine use (AOR = 3.11, 95%CI = 1.01–9.59, p = .049) independently predicted nonadherence. Furthermore, an additive association emerged, wherein the likelihood of PrEP nonadherence was highest among those who were hazardous/harmful drinkers and moderate/high risk cocaine users (OR = 2.25, 95%CI = 1.19–4.25, p = .013). Depression was not associated with nonadherence. Findings highlight the need to integrate alcohol- and substance-focused initiatives into PrEP care for gbMSM. Such initiatives, in turn, may help improve PrEP adherence and reduce the potential for HIV acquisition among this group.
登录
查看更多内容
影响因子：
6
作者：
Cherpitel, CJ;Ye, Y;Hao, W
通讯作者：
Hao, W
影响因子：
4.4
作者：
Grov C;Rendina HJ;John SA;Parsons JT
通讯作者：
Parsons JT
影响因子：
4.4
作者：
Abaasa A;Hendrix C;Gandhi M;Anderson P;Kamali A;Kibengo F;Sanders EJ;Mutua G;Bumpus NN;Priddy F;Haberer JE
通讯作者：
Haberer JE
DOI：
10.1093/cid/ciu266
发表时间：
2014-07
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Amico KR;Stirratt MJ
通讯作者：
Stirratt MJ
影响因子：
2.2
作者：
DUPONT, RL;BAUMGARTNER, WA
通讯作者：
BAUMGARTNER, WA