title: Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among individuals living with HIV who are unstably housed.
abstract: Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72-13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada. sparasha@sfu.ca
authors.forename: Surita
authors.initials: S
authors.lastname: Parashar
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Palmer
authors.forename: Nadia
authors.initials: N
authors.lastname: O'Brien
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Anya
authors.initials: A
authors.lastname: Shen
authors.forename: Suzy
authors.initials: S
authors.lastname: Coulter
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D001955:British Columbia; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006297:Health Services Accessibility; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012309:Risk-Taking; D012944:Social Support; D012959:Socioeconomic Factors