Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, 435C, Columbia, SC, 29208, USA.
South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
AIDS Behav. 2019 Nov;23(11):2904-2915. doi: 10.1007/s10461-019-02440-9.
People living with HIV are at increased risk for experiencing trauma, which may be linked to reduced adherence to antiretroviral therapy (ART), making it more difficult to achieve and maintain viral suppression. The current study sought to assess whether traumatic life experiences were associated with lower ART adherence among a diverse sample of people living with HIV in South Carolina. A cross-sectional survey was completed by 402 individuals receiving HIV care from a large immunology center. Principal component analysis revealed three primary categories of trauma experience (extreme violence/death-related trauma, physical and sexual assault, and accidental/disaster-related trauma). Multivariable logistic regression models using complete case analysis and multiple imputation were used to determine the associations between experiencing each trauma category and ART adherence. Complete case analysis showed that overall, participants who reported exposure to any trauma were 58% less likely to be adherent to their ART (adjusted OR 0.42; 95% CI 0.21-0.86) compared to respondents who did not experience trauma. Participants exposed to extreme violence/death-related trauma were 63% less likely to be adherent to their ART (adjusted OR 0.37; 95% CI 0.15-0.95) compared to respondents who did not experience trauma. Participants exposed to physical and sexual assault were 65% less likely (adjusted OR 0.35; 95% CI 0.16-0.77) and those who reported experiencing accidental/disaster-related trauma were 56% less likely (adjusted OR 0.44; 95% CI 0.21-0.93) to report being ART adherent compared to participants who did not experience trauma. Analyses with multiple imputation yielded similar findings as the complete case analyses. When the data were analyzed separately by gender, the associations between overall trauma, extreme violence/death-related trauma, and physical and sexual assault were statistically significant for men using complete case and multiple imputation analyses. There were no statistically significant associations between trauma and ART adherence among women. Findings highlight the need to adopt trauma-informed approaches and integrate trauma- and gender-specific interventions into HIV clinical care in the Southern United States.
HIV 感染者经历创伤的风险增加，这可能与抗逆转录病毒治疗（ART）的依从性降低有关，从而更难实现和维持病毒抑制。本研究旨在评估在南卡罗来纳州的 HIV 感染者多样化样本中，创伤经历是否与较低的 ART 依从性有关。通过对一家大型免疫学中心接受 HIV 护理的 402 人进行横断面调查。主成分分析显示，创伤经历有三个主要类别（极端暴力/与死亡相关的创伤、身体和性侵犯以及意外/灾害相关的创伤）。使用完全案例分析和多重插补的多变量逻辑回归模型来确定经历每个创伤类别的参与者与 ART 依从性之间的关联。完全案例分析显示，总体而言，与未经历创伤的受访者相比，报告暴露于任何创伤的参与者 ART 依从性低 58%（调整后的 OR 0.42；95%CI 0.21-0.86）。经历过极端暴力/与死亡相关的创伤的参与者，ART 依从性降低 63%（调整后的 OR 0.37；95%CI 0.15-0.95）。经历过身体和性侵犯的参与者，ART 依从性降低 65%（调整后的 OR 0.35；95%CI 0.16-0.77），经历过意外/灾害相关创伤的参与者，ART 依从性降低 56%（调整后的 OR 0.44；95%CI 0.21-0.93）。多元插补分析得到了与完全案例分析相似的结果。当按性别对数据进行单独分析时，在完全案例和多元插补分析中，总体创伤、极端暴力/与死亡相关的创伤以及身体和性侵犯与男性的关联具有统计学意义。在女性中，创伤与 ART 依从性之间没有统计学上的显著关联。研究结果强调需要采取创伤知情的方法，并将创伤和性别特异性干预措施纳入美国南部的 HIV 临床护理中。
