What Factors Are Predictive of Lower ART Adherence Among Hispanic, Latino MSM?

Younger age, poverty, recent drug use, depression, and unmet need for ancillary services were linked to lowered antiretroviral therapy (ART) adherence among HIV-positive Hispanic and Latino men who have sex with men (MSM), according to the CDC’s most recent Morbidity and Mortality Weekly Report.

The report also shows that most (63.9%) study participants had multiple reasons for missing at least 1 ART dose.

“Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts; however, nationally representative analyses are lacking,” the study authors pointed out.

Their findings were produced following an analysis of 2015-2019 data from the Medical Monitoring Project on 1673 Hispanic/Latino MSM, which used a 2-stage sampling method for 16 states and 1 territory followed by a random sampling of HIV-positive adults, via in-person or telephone interviews, in National HIV Surveillance System jurisdictions. All of the men self-identified as Hispanic or Latino and MSM and were currently on ART.

Overall, 57.4% (95% CI, 54.7%-60.1%) of the men self-reported that they took ART (ie, did not miss a dose), 52.9% said they had excellent adherence (95% CI, 49.9%-55.9%), and 69.2% said they always took their medication as recommended (95% CI, 66.4%-72.0%), in the previous 30 days.

However, ART adherence was shown to be lower among those who reported the following compared with those who did not:

• Drug use in the previous year: 67.2% vs 81.9%
• Recent history of depression: 66.3% vs 79.9%
• Unmet needs for ancillary services: 71.6% vs 83.0%

For this study, ancillary services comprised mental health and substance use disorder counseling, financial support, and food and housing assistance.

The most common reason for missing at least 1 ART dose was forgetting to take medication (63.1%), followed by change in routine/travel (42.3%) and falling asleep early/oversleeping (33.6%). Most (64%) had more than 1 reason for forgetting a dose.

An ART adherence score of 100 indicated perfect ART adherence. For this study, scores were classified as < 85 and ≥ 85. Most (77.3%) of the men had a score of ≥ 85, and in this group sustained viral suppression was more common: 75.3% vs 59.7% (prevalence ratio, 0.61; 95% CI, 0.51-0.74) with lower scores. However, compared with those living above the federal poverty level, fewer of the men living at or below that threshold had an ART adherence score of ≥ 85: 79.7% (95% CI, 78.8%-82.6%) vs 71.5% (95% CI, 66.8%-76.2%).

Most of the study participants were 49 years or younger, had been living with HIV for at least 10 years, attended Ryan White–funded facilities for usual HIV care, had been retained in HIV for the past year, and had public insurance only.

“This report highlights barriers to ART adherence faced by Hispanic/Latino MSM with diagnosed HIV infection,” the report concluded. “Culturally tailored interventions aimed at improving adherence, particularly among Hispanic/Latino MSM who are younger, live in poverty, use drugs, and have unmet needs for ancillary services, might improve viral suppression, leading to better health outcomes and decreasing HIV transmission.”

The report noted 3 important limitations to generalization of its findings:

1. Data from interviews were self-reported and therefore possibly subject to recall bias.
2. Possibility remains of residual nonresponse bias among the results, even after adjusting to minimize this influence.
3. Nonreport of all reasons for missing ART/low ART adherence

To improve ART adherence among Hispanic and Latino MSM and to encourage retention and engagement in care, the authors believe that interventions should support these goals, facilitate access to ancillary services, include ancillary services as part out outpatient HIV care, and include reminders to take their ART.

Reference

Crim SM, Tie Y, Beer L, Weiser J, Dasgupta S. Barriers to antiretroviral therapy adherence among HIV-positive Hispanic and Latino men who have sex with men — United States, 2015–2019. MMWR Morb Mortal Wkly Rep. 2020;69(40):1437-1442. doi:10.15585/mmwr.mm6940a1