TY - JOUR
T1 - Long-term consequences of interpersonal violence experiences on treatment engagement and health status in people living with HIV
AU - Budd, Alexandra S.
AU - Krentz, Hartmut B.
AU - Rubin, Leah H.
AU - Power, Christopher
AU - Gill, Michael J.
AU - Fujiwara, Esther
N1 - Funding Information:
We would like to thank the patients and staff at Southern Alberta Clinic for their time and participation in this research. A.B. collected the data, supervised by H.B.K., M.J.G., and L.H.R. conceived the original study idea. A.B. and E.F. performed the analyses. A.B. wrote the initial article, with help from H.B.K. and E.F. All authors contributed to the final version of the article. This study was supported by the Canadian Institutes of Health Research FRN: 201803. M.J.G. reports being an ad-hoc advisor on National HIV advisory Boards to Gilead, ViiV, and Merck.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Objective:To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort.Design:People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed.Methods:A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions.Results:At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (n=224, 21%) or adulthood experiences (n=161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+cell counts below 200/μl, and 65% more likely to die compared with patients not reporting IPersV (P<0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications.Conclusion:IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
AB - Objective:To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort.Design:People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed.Methods:A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions.Results:At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (n=224, 21%) or adulthood experiences (n=161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+cell counts below 200/μl, and 65% more likely to die compared with patients not reporting IPersV (P<0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications.Conclusion:IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
KW - HIV
KW - adult survivors of child abuse
KW - intimate partner violence
KW - longitudinal studies
KW - patient acceptance of healthcare
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U2 - 10.1097/QAD.0000000000002798
DO - 10.1097/QAD.0000000000002798
M3 - Article
C2 - 33369906
AN - SCOPUS:85103227114
SN - 0269-9370
VL - 35
SP - 801
EP - 809
JO - AIDS
JF - AIDS
IS - 5
ER -