title: Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings.
abstract: Successful biomedical prevention/treatment-as-prevention (TasP) requires identifying individuals at greatest risk for transmitting HIV, including those with antiretroviral therapy (ART) nonadherence and/or 'amplified HIV transmission risk,' defined as condomless sex with HIV-uninfected/unknown-status partners when infectious (i.e., with detectable viremia or STI diagnosis according to Swiss criteria for infectiousness). This study recruited sexually-active, HIV-infected patients in Brazil, Thailand, and Zambia to examine correlates of ART nonadherence and 'amplified HIV transmission risk'. Lower alcohol use (OR = .71, p < .01) and higher health-related quality of life (OR = 1.10, p < .01) were associated with greater odds of ART adherence over and above region. Of those with viral load data available (in Brazil and Thailand only), 40 % met Swiss criteria for infectiousness, and 29 % had 'amplified HIV transmission risk.' MSM had almost three-fold (OR = 2.89, p < .001) increased odds of 'amplified HIV transmission risk' (vs. heterosexual men) over and above region. TasP efforts should consider psychosocial and contextual needs, particularly among MSM with detectable viremia.
authors.affiliation: Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. jmagidson@mgh.harvard.edu.
authors.forename: Jessica F
authors.initials: JF
authors.lastname: Magidson
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.|Harvard School of Public Health, Boston, MA, USA.|The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.affiliation: FHI360, Durham, NC, USA.
authors.forename: Ayana T
authors.initials: AT
authors.lastname: Moore
authors.affiliation: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.|Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kriengkrai
authors.initials: K
authors.lastname: Srithanaviboonchai
authors.affiliation: Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.
authors.forename: Ruth Khalili
authors.initials: RK
authors.lastname: Friedman
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Limbada
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|University of Washington, Seattle, WA, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.affiliation: Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cummings
authors.affiliation: Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.affiliation: National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Elharrar
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Celentano
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Department of Psychology, University of Miami, Coral Gables, FL, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001938:Brazil; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011788:Quality of Life; D012306:Risk; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D013785:Thailand; D019562:Viral Load; D055815:Young Adult; D015024:Zambia; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Alcohol use; Amplified risk; Biomedical prevention; HIV transmission; MSM; Treatment as prevention