A Description of the Clinical and Socio-demographic Factors, Specifically Medication Coverage, Associated with Virologic Suppression of Those Living with HIV in Manitoba
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Date
2017-08-06
Authors
Briggs, Christopher
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Abstract
With antiretroviral therapy (ART), those living with Human Immunodeficiency Virus (HIV) have a
life-expectancy comparable to the general population. Virologic suppression, a treatment goal defined as an
HIV-1 RNA viral load of less than 200 copies/mL, is associated with better health outcomes and often a
negligible risk of viral transmission. Virologic suppression hinges on accessible ART, optimal adherence, and
long-term engagement in care. Manitobans can access ART through any of the following drug coverage
programs, each with their own set of eligibility criteria: Canadian Forces Health Services (CFHS), Interim
Federal Health Program (IFHP), Non-Insured Health Benefits (NIHB), Manitoba Pharmacare, Employment
and Income Assistance (EIA), private insurance, programs from other provinces, through clinical trials,
compassionate supply via pharmaceutical companies, or no coverage at all. In this project we used
participant socio-demographic data with clinical data (viral load, CD4 counts, and drug coverage program)
collected at distinct points in 2016 and 2017. In 2016, people who inject drugs (PWID) and those with
coverage via NIHB or EIA had lower rates of viral suppression than others without those characteristics. That
association was no longer seen for PWID and EIA coverage in 2017, with NIHB coverage being the only
significant predictor for an unsuppressed viral load. Although many Manitobans can access their ART at little
or no out of pocket cost, this is insufficient without other interventions that address systemic issues which
have caused the social inequities which may lead to sub-optimal adherence and decreased engagement with
care within populations associated with virologic failure.
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Keywords
antiretroviral therapy (ART), Human Immunodeficiency Virus (HIV)