Abstract
People living with HIV (PLWH) are disproportionately affected by mood, anxiety, and substance use disorders that prevent their sustained engagement with HIV care. Comprehensive research on the impact of these disorders on the HIV continuum of care is lacking. This study aimed to assess the impact of the syndemic between substance use disorder (SUD) and mood/anxiety disorders on the HIV continuum of care for PLWH in British Columbia (BC), Canada, and identify the stage with the highest attrition in the continuum. This retrospective population-based cohort study utilized data from the Comparative Outcomes And Service Utilization Trends (COAST) study that contains data on all diagnosed PLWH in BC. Eligible individuals were ≥ 19 years of age and were followed during 2001–2019. Our exposure variable was SUD or mood/anxiety disorder diagnoses. Our outcomes were the achievement of the following stages of the HIV continuum of care: (1) antiretroviral therapy (ART) initiation, (2) on-ART, (3) ART adherence, (4) viral suppression, and (5) maintained suppression. We estimated attrition by estimating the proportion of PLWH who proceed to each stage. Generalized linear mixed-effect models assessed the association between SUD and mood/anxiety disorders and the achievement of each stage while controlling for sociodemographic and HIV-related confounders. For the 14,398 eligible PLWH, maintained suppression exhibited the highest attrition. Having SUD or both SUD and mood/anxiety disorder were significantly associated with reduced odds of achieving all stages of the HIV continuum of care except on-ART. SUD had the strongest association with reduced odds of ART adherence (adjusted odds ratio (aOR) 0.47; 95% CI, 0.42–0.53) and reduced odds of maintained suppression (aOR 0.58; 95% CI, 0.53–0.63). Having only mood/anxiety disorders was also associated with reduced odds of both adherence (aOR 0.78; 95% CI, 0.71–0.87) and maintained suppression (aOR 0.82; 95% CI, 0.77–0.88). Our findings indicate that SUD and mood/anxiety disorders contribute to attritions across the continuum, emphasizing the need for integrated mental health and substance use services to support HIV care.
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Acknowledgements
The authors would like to thank the COAST study participants, BC Cancer Agency, BC Centre for Excellence in HIV/AIDS, BC Ministry of Health, BC Vital Statistics Agency, PharmaNet and the institutional data stewards for granting access to the data, and Population Data BC, for facilitating the data linkage process.
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This study has received approval from the University of British Columbia/Providence Health Care Research Ethics Board (H09-02905, H16-02036, and H20-03165). The study complies with the BC Freedom of Information and Protection of Privacy Act (FIPPA) and did not require informed consent as it is conducted retrospectively for research and statistical purposes only using anonymized administrative data. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5).
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COAST is funded by the Canadian Institutes of Health Research, through an Operating Grant (#130419), a Foundation Award to RSH (#143342) and support from the BC Centre for Excellence in HIV/AIDS. JSGM’s Treatment as Prevention (TasP) research, paid to his institution, has received support from the BC Ministry of Health, Health Canada, Public Health Agency of Canada, Vancouver Coastal Health and VGH Foundation. VDL is funded by a grant from the Canadian Institutes of Health Research (PJT-148595), and the Canadian Foundation for AIDS Research (CANFAR Innovation Grant – 30–101). SSN, LW, MB, KK and RSH declare that they have no conflict of interest.
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Shayegi-Nik, S., Wang, L., Li, J. et al. Impact of Substance Use and Mood/Anxiety Disorders on the HIV Continuum of Care in British Columbia, Canada, from 2001 to 2019. Int J Ment Health Addiction (2024). https://doi.org/10.1007/s11469-024-01272-6
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DOI: https://doi.org/10.1007/s11469-024-01272-6