Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons

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Abstract
Objective: Research on the role psychiatric factors in HIV disease management has yielded discrepant findings, possibly because prior studies did not include comprehensive psychiatric screeners. This study administered a validated screener to examine psychiatric correlates of highly active antiretroviral therapy (HAART) utilization and viral load. Design: Community-recruited, HIV-positive impoverished persons provided sociodemographic information, completed a Diagnostic Interview Schedule that screened for psychiatric disorders, and provided a blood sample to measure HIV disease markers. Methods: In this cross-sectional investigation with 227 participants, a multiple logistic regression model examined correlates of HAART utilization compared to a reference group that was eligible for (i.e. CD4+ cell count <350 cells/μl) but not taking HAART. A multiple linear regression model examined correlates of HIV viral load among 147 participants on HAART. Results: Sleeping on the street [adjusted OR (AOR) = 0.06; 95% confidence interval (CI) = 0.01–0.26] and screening positive for a stimulant use disorder (AOR = 0.29; 95% CI = 0.13–0.65) were independently associated with lower odds of HAART utilization. Conversely, enrollment in the AIDS Drug Assistance Program (AOR = 3.94; 95% CI = 1.45–10.73) and receipt of mental health treatment (AOR = 4.78; 95% CI = 1.77–12.87) were independently associated with increased odds of HAART utilization. Among those on HAART, screening positive for a severe mental illness was independently associated with a six-fold higher viral load. Conclusion: Providing psychiatric treatment could optimize health outcomes among HIV-positive impoverished persons and boost the effectiveness of ‘test and treat’ approaches to HIV prevention.

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