The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care

Int J STD AIDS. 2021 Feb;32(2):184-193. doi: 10.1177/0956462419890727. Epub 2020 Dec 15.

Abstract

In this study, we sought to assess the individual, syndemic, and interactive associations between individual-level factors and retention in care. The sample was derived from the Miami Adult Studies on human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) cohort from 2009 to 2014. The variables were entered into a multiple logistic regression with retention as the outcome. Backward regression, adjusting for all main effects, was conducted to determine which two-way interactions were associated with retention. Multivariable logistic regression was used to test which number of factors were associated with retention. Non-Hispanic Black race/ethnicity was associated with improved retention (odds ratio [OR] = 2.44, 95% confidence interval [CI]: 1.06-5.75, p ≤ 0.05) when compared to Non-Hispanic White persons. Black-Hispanic and Other racial/ethnic identities were associated with increased retention (OR = 4.84, 95%CI: 1.16-25.79, p ≤ 0.05 and OR = 7.24, 95%CI: 1.54-54.05, p ≤ 0.05, respectively) when compared to Non-Hispanic White persons. The interaction between depressive symptoms and Alcohol Use Disorder Identification Test (AUDIT, a test that assesses alcohol use disorder) score was significantly and negatively associated with retention in HIV care (OR = 0.14, 95%CI: 0.01-1.11, p ≤ 0.10). The interaction between age and male gender was also negatively associated with retention (OR = 0.95, 95%CI: 0.88-1.01, p ≤ 0.10), and the interaction between male gender and depression was positively associated with retention (OR = 7.17, 95%CI: 0.84-98.49, p ≤ 0.10). In conclusion, multiple races/ethnicities, specifically Non-Hispanic Black, Black-Hispanic, and Other racial/ethnic identification, were associated with increased odds of retention. Multiple interactions, specifically depressive symptoms * alcohol use disorder and male gender * age, were negatively associated with retention. The male gender * depression interaction was positively associated with retention in HIV care.

Keywords: Epidemiology; antiretroviral therapy; human immunodeficiency virus.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • Depression / epidemiology*
  • Educational Status
  • Ethnicity / statistics & numerical data*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • Health Knowledge, Attitudes, Practice
  • Hispanic or Latino
  • Humans
  • Male
  • Middle Aged
  • Retention in Care / statistics & numerical data*
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / epidemiology*
  • Syndemic