Department of Health Systems and Population Health, University of Washington, Seattle, USA.
School of Nursing Dept of Child, Family, and Population Health Nursing, University of Washington, Seattle, USA.
AIDS Behav. 2024 Jul;28(7):2239-2246. doi: 10.1007/s10461-024-04316-z. Epub 2024 Apr 24.
Lack of access to resources is a "fundamental cause" of poor HIV outcomes across the care cascade globally and may have the greatest impact on groups with co-existing marginalized identities. In a sample of people living with HIV (PWH) who inject drugs and were not on antiretroviral therapy (ART), we explored associations between access to resources and HIV severity. Fundamental Cause Theory (FCT) sees socioeconomic status/access to resources as a root cause of disease and emphasizes that individuals with limited resources have fewer means to mitigate health risks and implement protective behaviors, which ultimately generates disparities in health outcomes. Guided by the FCT, we hypothesized that resource depletion (primary aim) and lower income (secondary aim) were associated with increased HIV severity. Using baseline data from the Linking Infectious and Narcology Care (LINC-II) trial of ART-naive PWH who inject drugs in St. Petersburg, Russia (n = 225), we examined the association between "past year resource runout" (yes vs. no) and "low-income (< 300 USD a month)" and the outcome HIV severity (CD4 count, continuous). We fit two separate linear regression models adjusted for gender, age, time since HIV diagnosis, and prior ART use. Participants had a mean age of 37.5 years and were 60% male. Two thirds (66%) reported resource depletion, and 30% had income below 300 USD a month. Average CD4 count was 416 cells/mm (SD 285). No significant association was identified between either resource depletion or low-income and HIV severity (adjusted mean difference in CD4 count for resource depletion: - 4.16, 95% CI - 82.93, 74.62; adjusted mean difference in CD4 count for low-income: 68.13, 95% CI - 15.78, 152.04). Below-average income and running out of resources were common among PWH who inject drugs and are not on ART in St. Petersburg, Russia. Resource depletion and low-income were not significantly associated with HIV disease severity as captured by CD4 count. The nuanced relationship between socioeconomic status and HIV severity among people with HIV who inject drugs and not on ART merits further examination in a larger sample.
资源获取不足是全球艾滋病护理连续体中艾滋病毒治疗效果不佳的“根本原因”，并且可能对同时存在边缘化身份的群体产生最大的影响。在未接受抗逆转录病毒疗法 (ART) 的注射吸毒的艾滋病毒感染者 (PLHIV) 样本中，我们探讨了资源获取与艾滋病毒严重程度之间的关联。基础病因理论 (FCT) 将社会经济地位/资源获取视为疾病的根本原因，并强调资源有限的个体减轻健康风险和实施保护行为的手段较少，这最终导致健康结果的差异。在 FCT 的指导下，我们假设资源枯竭（主要目标）和低收入（次要目标）与艾滋病毒严重程度增加有关。利用俄罗斯圣彼得堡 LINC-II 试验中未接受 ART 的注射吸毒的 PLHIV 的基线数据（n=225），我们研究了“过去一年资源枯竭”（是/否）与“低收入（<300 美元/月）”与结局艾滋病毒严重程度（CD4 计数，连续）之间的关联。我们拟合了两个单独的线性回归模型，调整了性别、年龄、艾滋病诊断后时间和既往 ART 使用。参与者的平均年龄为 37.5 岁，60%为男性。三分之二（66%）报告资源枯竭，30%的人月收入低于 300 美元。平均 CD4 计数为 416 个细胞/mm（SD 285）。未发现资源枯竭或低收入与艾滋病毒严重程度之间存在显著关联（资源枯竭的 CD4 计数调整平均差异：-4.16，95%CI-82.93，74.62；低收入的 CD4 计数调整平均差异：68.13，95%CI-15.78，152.04）。在俄罗斯圣彼得堡未接受 ART 的注射吸毒的 PLHIV 中，收入低于平均水平和资源枯竭很常见。资源枯竭和低收入与 CD4 计数所反映的艾滋病毒疾病严重程度无显著相关性。在未接受 ART 的注射吸毒的 HIV 感染者中，社会经济地位与 HIV 严重程度之间的微妙关系值得在更大的样本中进一步研究。
