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.

Autor: Shuper PA; Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada. paul.shuper@camh.ca.; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada. paul.shuper@camh.ca., Joharchi N; Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada., Bogoch II; Divisions of General Internal Medicine and Infectious Diseases, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.; Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada., Loutfy M; Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.; Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.; Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada., Crouzat F; Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada., El-Helou P; Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada., Knox DC; Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada.; Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada., Woodward K; Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada., Rehm J; Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada.; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.; PAHO/WHO Collaborating Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada.; Epidemiological Research Unit, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.; Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187, Dresden, Germany.; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya str., Moscow, Russian Federation, 119991.; Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2020 Nov 25; Vol. 20 (1), pp. 1782. Date of Electronic Publication: 2020 Nov 25.
DOI: 10.1186/s12889-020-09883-z
Abstrakt: Background: 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).
Methods: 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.
Results: 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 (χ 2 (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.
Conclusions: 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.
Databáze: MEDLINE
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