Antiretroviral therapy abandonment among adolescents and young people with HIV/AIDS during COVID-19: A case-control study

Piran, Camila Moraes Garollo; Cargnin, Alana Vitória Escritori; Shibukawa, Bianca Machado Cruz; Oliveira, Natan Nascimento de; Silva, Marcelo da; Furtado, Marcela Demitto

doi:10.1590/1518-8345.6497.3948

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6497.3948 copy

Antiretroviral therapy abandonment among adolescents and young people with HIV/AIDS during COVID-19: A case-control study^* * Paper extracted from master’s thesis “Preditores para o abandono da terapia antirretroviral entre adolescentes e jovens vivendo com hiv/aids”, presented to Universidade Estadual de Maringá, Maringá, PR, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to identify the factors associated with antiretroviral therapy abandonment among adolescents and young people living with HIV/AIDS during the COVID-19 pandemic.

Method:

a case-control study carried out between 2020 and 2021 in Maringá, Paraná. The cases corresponded to the following: adolescents and young people (aged from 10 to 24 years old) diagnosed with HIV/AIDS and who abandoned treatment, while the Control Group consisted of people with similar sociodemographic characteristics, diagnosed with HIV/AIDS and with no history of treatment abandonment. Pairing of the cases and controls was by convenience, with four controls for each case. The research instrument presented sociodemographic variables, clinical characteristics and others, whose association with treatment abandonment was analyzed by means of logistic regression.

Results:

a total of 27 cases and 109 controls were included in the study (1/4 ratio). The variable associated with an increased chance of abandonment was age close to 22.8 years old (OR_adj: 1.47; 95% CI: 1.07-2.13; p=0.024). Sporadic condom use (OR_adj: 0.22; 95% CI: 0.07-0.59; p=0.003) and having an opportunistic infection (OR: 0.31; 95% CI: 0.10-0.90; p=0.030) were protective factors.

Conclusion:

age close to 23 years old at the last consultation was associated with antiretroviral therapy abandonment. The presence of opportunistic infections and condom use are determining factors for treatment continuity during COVID-19.

Descriptors:
HIV; Acquired Immunodeficiency Syndrome; COVID-19; Patient Dropouts; Adolescent; Young Adult

Highlights:

(1) Age close to 22.8 years old increases the chances of antiretroviral therapy abandonment.

(2) The distance to the service is a control variable that favors abandonment.

(3) Sporadic condom use and opportunistic infections are protective factors.

(4) Adolescents and young people have more vulnerable behaviors.

(5) Reflections on antiretroviral therapy abandonment during COVID-19.

Sociodemographic characteristics	Abandonment	Non-abandonment	Total	p value*
	n=27	n=109	N=136
	n(%)^†	n(%)^†	N(%)^†
Age at diagnosis (years)				0.764^‡
15-19	3 (11.0)	17 (16.0)	20 (14.7)
20-24	24 (89.0)	92 (84.0)	116 (85.3)
Age at last consultation				0.132^§
	22.8 (1.2)^\|\|	22 (2.8)^\|\|	22.1(2.6)^\|\|
Gender				>0.999^‡
Female	3 (11.0)	12 (11.0)	15 (11.0)
Male	24 (89.0)	97 (89.0)	121 (71.3)
Marital status				>0.999^‡
No partner	24 (89.0)	97 (89.0)	121 (89.0)
Has a partner	3 (11.0)	12 (11.0)	15 (11.0)
Sexual orientation				0.330^‡
Heterosexual	5 (19.0)	12 (11.0)	17 (12.5)
Homosexual/Bisexual	22 (81.0)	97 (89.0)	119 (87.5)
Skin color/Race				0.233^‡
Asian	0 (0.0)	1 (1.8)	1 (1.2)
White	19 (70.0)	26 (47.3)	45 (54.9)
Brown	7 (26.0)	23 (41.8)	30 (36.6)
Black	1 (3.7)	5 (9.1)	6 (7.3)
Schooling				>0.999^‡
<12 years	19 (90.0)	81 (90.0)	100 (90.1)
12+ years	2 (9.5)	9 (10.0)	11 (9.9)
Occupation				0.793^‡
Services	5 (19.0)	16 (15.0)	21 (15.4)
Technical/Higher Level Occupation	6 (22.0)	29 (27.0)	35 (25.7)
Others (Unemployed/Housewife)	16 (59.0)	64 (59.0)	80 (58.8)
Area of residence				0.488^‡
Rural	1(3.7)	2(1.8)	3 (2.2)
Urban	26(96.0)	107(98.0)	133 (97.8)
Housing				0.952^¶
Lives alone	9 (33.0)	40(37.0)	49 (36.3)
Lives with family members/partner	15(56.0)	56(52.0)	71 (52.6)
Lives with friends/acquaintances	3(11.0)	12(11.0)	15 (11.1)
Distance to the service (in km ^** )				0.012^§
	17.3(20)^\|\|	10.9(13.3)^\|\|	12.2(15)^\|\|
Distance to the service (in min ^†† )				0.052^§
	66.8(33.5)^\|\|	56.1(38)^\|\|	58.2(37.3)^\|\|

Epidemiological and behavioral characteristics	Abandonment	Non-abandonment	Total	p value*
	n=27	n=109	N=136
	n(%)^†	n(%)^†	N(%)^†
Alcohol use				0.334^‡
Yes	13 (48.0)	41 (38.0)	54 (40.0)
No	14 (52.0)	67 (62.0)	81 (60.0)
Tobacco use				0.092^‡
Yes	13 (48.0)	71 (66.0)	84 (62.2)
No	14 (52.0)	37 (34.0)	51 (37.8)
Illicit drugs				0.296^‡
Yes	17 (63.0)	79 (73.0)	96 (71.1)
No	10 (37.0)	29 (27.0)	39 (28.9)
Condom use				0.006^§
Never	15 (56.0)	29 (27.0)	44 (32.4)
Sometimes	8 (30.0)	67 (61.0)	75 (55.1)
Always	4 (15.0)	13 (12.0)	17 (12.5)
Type of sex partner				0.463^‡
Occasional	14 (52.0)	65 (60.0)	79 (58.1)
Steady	13 (48.0)	44 (40.0)	57 (41.9)
HIV+ partner				0.523^§
No	2 (7.4)	17 (16.0)	19 (14.0)
Yes	8 (30.0)	25 (23.0)	33 (24.3)
I don’t know	17 (63.0)	67 (61.0)	84 (61.8)
Comorbidities				>0.999^§
Yes	1 (3.7)	5 (4.6)	6 (4.4)
No	26 (96.0)	104 (95.0)	130 (95.6)
Diagnosis of mental disorders				0.784^§
Yes	4 (15.0)	20 (18.0)	24 (17.7)
No	23 (85.0)	89 (82.0)	112 (82.3)
Use of psychotropic drugs				0.764^§
Yes	3 (11.0)	17 (16.0)	20 (14.7)
No	24 (89.0)	92 (84.0)	116 (85.3)

Characteristics of diagnosis and monitoring	Abandonment	Non-abandonment	Total	p value*
	n=27	n=109	N=136
	n(%)^†	n(%)^†	N(%)^†
Referral locus				0.301^‡
CTA ^§	12 (44.0)	66 (61.0)	78 (57.4)
Hospital/Blood Center	1 (3.7)	7 (6.4)	8 (5.9)
Transfer from another SAE^\|\|	10 (37.0)	26 (24.0)	36 (26.5)
BHU^¶	4 (15.0)	10 (9.2)	14 (10.3)
Opportunistic infections				0.065^**
Yes	17 (63.0)	87 (80.0)	104 (76.5)
No	10 (37.0)	22 (20.0)	32 (23.5)
First viral load result				0.047^††
	83,537.6 (244,813.8)^‡‡	115,807.7 (196,625.6)^‡‡	110,253.0 (204,958.0)^‡‡
Last viral load result				0.538^††
	11,801.5 (18,348.1)^‡‡	83,612.6 (204,373.0)^‡‡	64,804.9 (177,948.0)^‡‡
First CD4+ ^§§ result				0.113^††
	605.9 (296.3)^‡‡	589.2 (743.4)^‡‡	592.1 (684.9)^‡‡
Last CD4+ ^§§ result				0.004^††
	1,499.2 (3,038.8)^‡‡	1,105.6 (3,620.2)^‡‡	1,174.2 (3,516.0)^‡‡

Estimation of the Logistic Regression Model Parameters
Variables	OR^†	95% CI^‡	OR_adj^§	95% CI^‡	p value^\|\|
Age at last consultation
Mean of 22.8	1.27	[0.99-1.71]	1.47	[1.07-2.13]	0.024
Distance to the service (in km ^¶ )
Mean of 17.3	1.02	[0.99-1.04]	1.02	[0.99-1.05]	0.101
Condom use
Never	1	-	1	-	-
Sometimes	0.23	[0.08-0.59]	0.22	[0.07-0.59]	0.003
Always	0.59	[0.14-2.02]	0.41	[0.08-1.56]	0.217
Opportunistic infections
No	1	-	1	-	-
Yes	0.42	[0.17-1.09]	0.31	[0.10-0.90]	0.030
Adequacy of the Predictive Logistic Model by the ROC Curve*
Overall Accuracy	0.63	[0.47-0.78]			0.001
Sensitivity	0.83
Specificity	0.60

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[1] Corresponding author:
Camila Moraes Garollo Piran E-mail: camilagarollo@gmail.com https://orcid.org/0000-0002-9111-9992