A Description of the Clinical and Socio-demographic Factors, Specifically Medication Coverage, Associated with Virologic Suppression of Those Living with HIV in Manitoba

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.