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Correlates of adherence to antiretroviral therapy in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam. MR Jordan 1 , H Sheehan 1 , ND Hien 2 , TTM Lien 2 , N Terrin 3 , NV Trung 2 , NTB Ha 2 , DV Duong 2 , C Wanke 1 , NV Kinh 2 , AM Tang 1

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  1. Correlates of adherence to antiretroviral therapy in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam MR Jordan1, H Sheehan1, ND Hien2, TTM Lien2, N Terrin3, NV Trung2, NTB Ha2, DV Duong2, C Wanke1, NV Kinh2, AM Tang1 1Tufts University School of Medicine, Boston, USA; 2National Hospital of Tropical Diseases, Hanoi, Viet Nam; 3Tufts Medical Center, Boston; USA

  2. Background (1) 1 The first case of HIV in Vietnam was reported in 1990 In 2006, 280,000 had been reported representing an overall prevalence of 0.5% among adults (aged 15-49 years) Injection drug users (IDU) account for more than 56% of all reported HIV infections1 HIV prevalence in IDU estimated at 29%-34.0 %, with wide geographical variation2 1Nguyen et al. Addiction 2008; 2Matehers et al. Lancet, 2008

  3. Background (2) In 2005, Vietnam began rapid ART scale-up supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) As of end 2009, over 36,000 adults and 2,000 children were receiving ART1 In 2009, Vietnam strengthened its commitment to provide ART to IDUs and strengthen harm reduction programs2 1Vietnam Authority of HIV/AIDS Control, 2010; 2Guidelines for HIV care and treatment, Hanoi Vietnam, 2009

  4. Background (3) 1Jordan et al. Int J STD AIDS 2009; 2Oyugi et al. IDS 2007; 3Bangsberg et al. Current HIV/AIDS report 2007; 4Bangsberg et al. AIDS 2006; 5Lewis et al. AIDS care 2006; 6Chandler et al JAIDS 2006; 7Arnsten J Gen Int Med 2002; 8Jaquet Addiction 2010; Hendershot et al. J AIDS 2000; Do IAS 2010 TUPDX103 Rates of viral suppression in Vietnamese drug users (DU) comparable to rates seen in other populations1 Optimal adherence to ART required for viral suppression and prevention of HIVDR2-5 Previous studies have identified active drug use, poor social supports, and hazardous alcohol use as correlates of poor adherence to ART6-10

  5. Objective Purpose to assess correlates of adherence to ART in a cohort of DUs receiving ART at a large urban clinic in Hanoi, Vietnam Hypotheses: active drug use, hazardous alcohol use, lack of social support are correlates of poor ART adherence

  6. Methods (1) Between June and November 2006, 300 HIV infected and uninfected patients were enrolled into a 36-month prospective study on HIV and nutrition This analysis focuses on 100 HIV positive patients receiving ART for at least 6 months prior to enrolment Patients enrolled from outpatient clinic at the National Hospital of Tropical Diseases, Hanoi, Vietnam

  7. Methods (2) • Inclusion criteria • HIV positive • Age ≥18 • Received ART at NHTD for at least six months • History of injection drug use within the previous 5-years • Informed consent signed consent • Study approval by the Institutional Review Board of Tufts University (Boston) and ethical review board of the Hanoi School of Public Health

  8. Data collection HIV-1 RNA; CD4+ cell count HCV Ab, HBsAg Fasting blood draw: triglycerides, total cholesterol, LDL, HDL, insulin, glucose, vitamins A, E, zinc, and selenium Body composition: height, weight, skinfold measures, circumferences, and BIA 24-hour dietary recall Lifestyle Questionnaire

  9. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Likert Scale Thinking back over the past 30 days, on average how would you rate your ability to take all your medications as prescribed? Visual Analogue Scale Please place an “X” on the line below at the point showing your best guess as to how much of your total antiretroviral medications you have taken in the past 30 days.

  10. Baseline characteristics (1)

  11. Baseline characteristics (2) *National Institute on Alcohol and Alcoholism

  12. Baseline characteristics (3)

  13. Baseline characteristics (4)

  14. Baseline characteristics (5)

  15. VAS Distribution among virally suppressed participants La et al. 4th Intl Conf HIV Treatment Adherence, 2009

  16. Likert Distribution among virally suppressed participants La et al. 4th Intl Conf HIV Treatment Adherence, 2009

  17. Statistical Analysis • Outcome: Adherence, Likert scale; dichotomized as Excellent/Very Good vs. Good/Fair/Poor • Analysis includes data from 524 visits with complete questionnaire and adherence data • Statistical model: repeated measures logistic regression (SAS V 9.2)

  18. Statistical Analysis (2) • Correlates of adherence examined: • Drug use • Alcohol use • Living situation (alone vs. with others) • Duration of ART (years) • Self-reported symptoms (nausea, vomiting, stomach pain, fever, white patches, mouth lip gum pain)

  19. Results

  20. Summary Results demonstrate a significant correlation between poorer adherence: Active drug use in the last 6 months Duration of ART

  21. Conclusion Strengthening of harm reduction programs for HIV infected DUs and scale-up of methadone maintenance may support initiation and adherence to ART among IDU in Vietnam Programmatic supports for adherence beyond the first 12 months of therapy may be indicated Additional operational research/interventions aimed at building social capital and decreasing stigma may support long-term adherence to ART

  22. Acknowledgements Tufts University School of Medicine Sherwood Gorbach James Hellinger Rony Barbara National institutes of Health K23 AI074423 (PI Jordan) P30DA013868 (PI Gorbach) R01DA022163 (PI Gorbach) Patients who participated in the study National Hospital of Tropical Disease Dung Nguyen Huong Le Ha N. Nguyen Trang Van Phuong Nguyen Hai Pham Hoa Le Khuong T.Pham Thuc T. Nguyen Tien Q. Luu

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