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Sticking to It: The Effect of Maximally Assisted Therapy on Antiretroviral Treatment Adherence Among Individuals Living with HIV Who are Unstably Housed

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Abstract

Housing is a known determinant of health behaviors, which includes adherence to Antiretroviral Therapy (ART). Within the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, unstable housing is inversely associated with adherence. Several comprehensive adherence support services have emerged to improve adherence for unstably housed or otherwise vulnerable populations. The Maximally Assisted Therapy (MAT) program in Vancouver, British Columbia uses a multidisciplinary approach to support HIV-positive clients with a history of addictions or mental illness, many of whom also experience episodic homelessness. This study investigated the association between antiretroviral adherence and use of support services, including the MAT program, amongst people living with HIV and AIDS who are unstably housed in the LISA sample. Of the 212 unstably housed participants, those who attended the MAT program were 4.76 times more likely to be ≥95% adherent (95% CI 1.72–13.13; P = 0.003) than those who did not. The findings suggest that in the absence of sustainable housing solutions, programs such as MAT play an important role in supporting treatment adherence in this population.

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Acknowledgments

The LISA research team is thankful for the cooperation of our various research sites. We are inspired by their amazing dedication to their clients and the communities that they serve. In particular, the program nurses, social workers, pharmacists and other frontline workers at the MAT program were instrumental in the development of this manuscript. We are also grateful for the contributions of the LISA Community Advisory Committee: Terry Howard, Rosa Jamal, Isabella Kirchner, Sandy Lambert, Kecia Larkin, Steve Levine, Melissa Medjuck, Stacie Migwans, Sam Mohan, Lori Montgomery, Glyn Townson, Michelle Webb, Sarah White and study co-investigators: Dr. Rolando Barrios, Dr. David Burdge, Dr. Marianne Harris, Dr. David Henderson, Dr. Thomas Kerr, Dr. Julio S. G. Montaner, Dr. Thomas Patterson, Dr. Eric Roth, Dr. Mark W. Tyndall, Dr. Brian Willoughby and Dr. Evan Wood. We would especially like to thank the participants of the LISA study who trust us with sensitive and intimate information and share their stories in hopes of supporting research projects that will make a difference in their communities. We humbly listen and interpret their experiences and hope that we are doing them justice.

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Authors and Affiliations

  1. BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Surita Parashar, Alexis K. Palmer, Nadia O’Brien, Keith Chan, Anya Shen, Julio S. G. Montaner & Robert S. Hogg

  2. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada

    Surita Parashar, Alexis K. Palmer & Robert S. Hogg

  3. Maximally Assisted Therapy Program, Vancouver Coastal Health Authority/BC Centre for Excellence in HIV/AIDS, Downtown Community Health Centre, 569 Powell Street, Vancouver, BC, V6A 1G8, Canada

    Suzy Coulter

  4. Department of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada

    Julio S. G. Montaner

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  1. Surita Parashar
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Correspondence to Surita Parashar.

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Parashar, S., Palmer, A.K., O’Brien, N. et al. Sticking to It: The Effect of Maximally Assisted Therapy on Antiretroviral Treatment Adherence Among Individuals Living with HIV Who are Unstably Housed. AIDS Behav 15, 1612–1622 (2011). https://doi.org/10.1007/s10461-011-0026-8

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