University of California San Francisco, School of Medicine, San Francisco, CA, USA.
Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2023 Jul-Aug;27(4):102779. doi: 10.1016/j.bjid.2023.102779. Epub 2023 May 22.
Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced ≥ 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.
影响女性在 HIV 护理中保留的综合心理社会和生殖因素仍未得到充分研究。我们分析了 2000 年至 2015 年巴西 HIV 女性队列中非保留相关因素。参与者自我报告了身体/性暴力、非法药物使用、青少年怀孕或人工流产的暴露情况。根据这些心理社会压力源的存在与否，使用终生病史来创建基于这些条件的综合评分。所有二分变量均相加（范围 0 至 4），得分越高表示经历的综合因素越多。逻辑回归模型确定了非保留的预测因素，定义为在入组后的第一年中 HIV 病毒载量或 CD4 结果< 2 次。在 915 名女性中，有 18%观察到非保留。综合因素的流行率为青少年怀孕（53.2%）、身体/性暴力（38.3%）、人工流产（27.3%）和非法药物使用（17.2%）；41.2%的人经历了≥ 2 种综合条件。综合评分 2 和 3 与非保留相关，与低教育程度、HIV 感染年限和流行梅毒有关。心理社会和生殖综合因素会限制女性在 HIV 护理中的保留。梅毒感染预测非保留，未来的研究可以探索其作为综合因素的可能性。
