Self-reported Nonadherence to Antiretroviral Therapy Among Miami-Dade Ryan White Program Clients During the COVID-19 Pandemic: A Cross-sectional Study.
Melissa K Ward, Stephanie Aleite, Diana M Sheehan and 5 others
PMID 36607312WHAT IT FOUND
Among Ryan White clients, missing HIV medication doses was linked to harder access to their HIV doctor and pandemic financial hardship.
Ask about both when assessing adherence.
Key findings
0112.7% of participants reported missing one or more HIV medication doses during the previous four days.
02In the adjusted model, clients reporting greater difficulty accessing their HIV doctor had adjusted OR=3.6 (1.4-9.2) for ART nonadherence, and clients reporting pandemic financial impacts had adjusted OR=4.2 (1.5-12.2).
03Among clients with financial impacts (n=212), harder HIV doctor access was associated with ART nonadherence (crude OR=3.9, 1.5-10.2); among clients without financial impacts (n=78), the association was not significant (crude OR=0.7, 0.1-8.1).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The survey was cross-sectional, so it cannot show that difficulty accessing care or financial hardship caused missed doses. Nonadherence was self-reported, and respondents were more engaged in care than the broader Miami-Dade Ryan White population. In the sample, 92% were virally suppressed in 2019, compared with 82% in the overall Miami-Dade Ryan White population, so the sample may underrepresent clients at higher risk. The stratified analyses were post-hoc, unadjusted, and small, especially the subgroup without financial impacts (n=78), so they should be read as exploratory only. Selection bias was possible because women, Black/African American, and Haitian clients were oversampled, although weights were used. Unmeasured confounding, such as substance use, may explain some associations.
Declared interests
The supplied metadata lists NIH extramural research support; the article text does not state author conflicts of interest.
The easy way to misread this
Do not conclude that improving HIV doctor access or financial support will reduce missed doses. This was a self-reported cross-sectional survey, so the associations could reflect other factors, and the subgroup finding was exploratory and unadjusted.