Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Sydney, Australia.
Nai Zindagi Trust, Islamabad, Pakistan.
Int J Drug Policy. 2021 Oct;96:103281. doi: 10.1016/j.drugpo.2021.103281. Epub 2021 May 17.
People who inject drugs (PWID) living with HIV have poorer adherence to HIV antiretroviral therapy (ART) and elevated mortality compared to other populations. Little is known about factors associated with adherence among PWID in low-and middle-income countries, including in countries where opioid agonist therapy (OAT) is unavailable. We aimed to estimate ART adherence among men who inject drugs (MWID) living with HIV in Pakistan and identify factors independently associated with adherence.
Nai Zindagi Trust (NZT) provides a range of HIV prevention, testing and treatment services to PWID in Pakistan. This study utilized data from HIV positive MWID who received ART refill/s from public sector ART Centres via NZT's Social Mobilizer Adherence Support Unit between September 2016 and December 2018. Multivariable logistic regression modelled factors independently associated with ART adherence.
Among 5,482 HIV positive MWID registered with NZT who had attended the AAU and were supplied with ART refills between September 2016 and December 2018., 55% were adherent to ART. Independent predictors of adherence were being married (AOR 1.38, 95% CI:1.23-1.55, p<0.001) and >5 years of education compared to those with no education (AOR 1.19, 95% CI:1.05-1.35, p = 0.005). MWID living on the street at night had lower adjusted odds of ART adherence (AOR 0.75, 95% CI:0.62-0.91, p = 0.003).
Findings indicate that MWID living with HIV continue to face barriers to ART adherence in Pakistan. Despite considerable evidence supporting the impact of OAT in increasing ART adherence among PWID, OAT remains illegal and inaccessible in Pakistan. Evidence-based interventions, including OAT, are needed to increase adherence and improve clinical outcomes, health equity and survival among PWID living with HIV in Pakistan.
与其他人群相比，感染艾滋病毒的吸毒者（PWID）接受艾滋病毒抗逆转录病毒疗法（ART）的依从性更差，死亡率更高。在包括阿片类药物激动剂治疗（OAT）不可用的国家在内的低收入和中等收入国家，人们对与 PWID 接受 ART 治疗的依从性相关的因素知之甚少。我们旨在估计巴基斯坦感染艾滋病毒的男性吸毒者（MWID）的 ART 治疗依从性，并确定与依从性独立相关的因素。
Nai Zindagi Trust（NZT）为巴基斯坦的吸毒者提供了一系列艾滋病毒预防、检测和治疗服务。本研究利用了 2016 年 9 月至 2018 年 12 月期间，通过 NZT 的社会动员者依从性支持股从公共部门 ART 中心接受 ART 续药的 HIV 阳性 MWID 接受 ART 治疗的数据。多变量逻辑回归分析了与 ART 治疗依从性独立相关的因素。
在 2016 年 9 月至 2018 年 12 月期间，登记参加 NZT 的 5482 名 HIV 阳性 MWID 中有 55% 接受了 ART 治疗。依从性的独立预测因素包括已婚（AOR 1.38，95%CI：1.23-1.55，p<0.001）和接受过 5 年以上教育，与未接受过教育的人相比（AOR 1.19，95%CI：1.05-1.35，p=0.005）。夜间在街头生活的 MWID 接受 ART 治疗的调整后 odds 较低（AOR 0.75，95%CI：0.62-0.91，p=0.003）。
这些发现表明，在巴基斯坦，感染艾滋病毒的吸毒者继续面临接受 ART 治疗的障碍。尽管有大量证据表明 OAT 可以提高 PWID 接受 ART 治疗的依从性，但在巴基斯坦，OAT 仍然是非法的，无法获得。需要采取循证干预措施，包括 OAT，以提高依从性，改善临床结果，促进健康公平，并提高巴基斯坦感染艾滋病毒的吸毒者的生存率。
