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      COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts

      research-article
      a , * , b , c , a , c , a , c , a , d , e , f , g , h , g , i , c
      Drug and Alcohol Dependence
      Elsevier B.V.
      ART, Antiretroviral therapy, C3PNO, Collaborating Consortium of Cohorts Producing NIDA Opportunities, COVID, Coronavirus disease, HIV, Human immunodeficiency virus, NIDA, National Institute on Drug Abuse, USAUDIT-C, United States Alcohol Use Disorders Identification Test – Consumption questions, antidepressant therapy, care cascade, depression, depressive symptoms, viral non-suppression

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          Abstract

          Background

          The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic.

          Methods

          From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week.

          Results

          Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment.

          Conclusions

          Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.

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          Most cited references51

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          Prevention of HIV-1 infection with early antiretroviral therapy.

          Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. In nine countries, we enrolled 1763 couples in which one partner was HIV-1-positive and the other was HIV-1-negative; 54% of the subjects were from Africa, and 50% of infected partners were men. HIV-1-infected subjects with CD4 counts between 350 and 550 cells per cubic millimeter were randomly assigned in a 1:1 ratio to receive antiretroviral therapy either immediately (early therapy) or after a decline in the CD4 count or the onset of HIV-1-related symptoms (delayed therapy). The primary prevention end point was linked HIV-1 transmission in HIV-1-negative partners. The primary clinical end point was the earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death. As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years; 95% confidence interval [CI], 0.9 to 1.7); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years, 95% CI, 0.6 to 1.3). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04; 95% CI, 0.01 to 0.27; P<0.001). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59; 95% CI, 0.40 to 0.88; P=0.01). The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events, indicating both personal and public health benefits from such therapy. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 052 ClinicalTrials.gov number, NCT00074581.).
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            Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection

            New England Journal of Medicine, 373(9), 795-807
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              Ending the HIV Epidemic

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                Author and article information

                Journal
                Drug Alcohol Depend
                Drug Alcohol Depend
                Drug and Alcohol Dependence
                Elsevier B.V.
                0376-8716
                1879-0046
                12 February 2022
                12 February 2022
                : 109355
                Affiliations
                [a ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St., Baltimore, MD 21205, United States
                [b ]Division of Infectious Diseases, Johns Hopkins School of Medicine, 600N. Wolfe St., Baltimore, MD 21287, USA
                [c ]Division of General Internal Medicine, Johns Hopkins School of Medicine, 600N. Wolfe St., Baltimore, MD 21287, USA
                [d ]University of Southern California, Children’s Hospital Los Angeles, CHL 4650W. Sunset Blvd., Los Angeles, CA 90027, USA
                [e ]Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
                [f ]Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, California 90024, USA
                [g ]Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
                [h ]Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625N Michigan Ave, Chicago Illinois 60611, USA
                [i ]Frontier Science Foundation, 4033 Maple Road, Amherst, New York, 14226, USA
                Author notes
                [* ]Correspondence to: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St., Baltimore, MD 21205, Fax: +410-955-0863.
                Article
                S0376-8716(22)00092-8 109355
                10.1016/j.drugalcdep.2022.109355
                8837482
                35331581
                12245910-dec3-428f-9ba1-ce1179e47078
                © 2022 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 16 August 2021
                : 20 December 2021
                : 10 January 2022
                Categories
                Article

                Health & Social care
                art, antiretroviral therapy,c3pno, collaborating consortium of cohorts producing nida opportunities,covid, coronavirus disease,hiv, human immunodeficiency virus,nida, national institute on drug abuse,usaudit-c, united states alcohol use disorders identification test – consumption questions,antidepressant therapy,care cascade,depression,depressive symptoms,viral non-suppression

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