Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Kristopher Fennie

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Gladys Ibanez

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Tan Li

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Marianna Baum

Fourth Advisor's Committee Title

Committee Member

Keywords

HIV, syndemics, alcohol use, drug abuse

Date of Defense

11-15-2019

Abstract

This dissertation assessed the following: 1) the individual-level factors’ individual, syndemic, and interactive associations with retention in HIV care; 2) the individual-level factors’ individual, syndemic, and interactive associations with adherence among retained persons; and 3) the individual-level factors’ individual, syndemic, and interactive associations with viral suppression among retained persons. In the first study, Non-Hispanic Black race/ethnicity was associated with improved retention (OR=2.44, 95%CI: 1.06–5.75, p≤0.05). “Black-Hispanic” and “Other” racial/ethnic identities were associated with increased retention among participants (OR=4.84, 95%CI: 1.16–25.79, p≤0.05 and OR=7.24, 95%CI: 1.54–54.05p≤0.05, respectively). The interaction between depressive symptoms and alcohol use disorder was significantly and negatively associated with retention in HIV care (OR=0.14, 95%CI: 0.01–1.11, p≤0.10). This negative interaction suggests that the impact of depression on retention differs by alcohol use disorder (or equivalently the impact of alcohol use disorder on retention differs by depression status). 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). This suggests that the impact of male gender on retention may be influenced by increased age (or equivalently the effect of age on retention varies by male gender). The interaction between male gender and depression was positively associated with retention (OR=7.17, 95%CI: 0.84–98.49, p≤0.10). Given our understanding of previous literature, we interpreted this as the impact of depression on retention in care is influenced by male gender. In the second study, we determined that cocaine use was significantly and negatively associated with short term adherence when compared to persons who tested negative for cocaine use (OR=0.23, 95%CI: 0.05–0.86, p=0.05) when adjusting for all other factors. Education had a significant negative association with long term adherence (OR=0.73, 95%CI: 0.57–0.91, p=0.01). In the final study, among 51 retained persons with HIV we determined Non-White race/ethnicity (OR=0.28, 95%CI: 0.05–1.12, p=0.09), education (OR=0.75, 0.52–1.03, p=0.10), and male gender (OR=0.33, 95%CI: 0.09–1.05. p=0.07) were marginally and negatively associated with viral suppression. Collectively, our study findings suggest that multiple individual level factors individually and interactively have a deleterious effect on multiple stages of the HIV care continuum.

Identifier

FIDC008862

ORCID

https://orcid.org/0000-0001-5631-7646

Previously Published In

Myers, K., Li, T., Baum, M., Ibanez, G., Fennie, K. (accepted). The Individual, Interactive, and Syndemic Effect of Substance Use, Depression, Education, and Ethnicity on Retention in HIV Care. International Journal of STDs and AIDS

Available for download on Wednesday, November 03, 2021

Included in

Epidemiology Commons

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