@article{ref1,
title="Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure  Prophylaxis (PrEP) nonadherence among gay, bisexual, and other  men-who-have-sex-with-men",
journal="BMC public health",
year="2020",
author="Shuper, Paul A. and Joharchi, Narges and Bogoch, Isaac I. and Loutfy, Mona and Crouzat, Frederic and El-Helou, Philippe and Knox, David C. and Woodward, Kevin and Rehm, Jürgen",
volume="20",
number="1",
pages="e1782-e1782",
abstract="BACKGROUND: Although HIV pre-exposure prophylaxis (PrEP) substantially diminishes  the likelihood of HIV acquisition, poor adherence can decrease the HIV-protective  benefits of PrEP. The present investigation sought to identify the extent to which  alcohol consumption, substance use, and depression were linked to PrEP nonadherence  among gay, bisexual, and other men-who-have-sex-with-men (gbMSM). <br><br>METHODS: gbMSM  (age ≥ 18, prescribed PrEP for ≥3 months) were recruited from two clinics in  Toronto, Canada for an e-survey assessing demographics; PrEP nonadherence (4-day  PrEP-focused ACTG assessment); hazardous and harmful alcohol use (AUDIT scores of  8-15 and 16+, respectively); moderate/high risk substance use (NIDA M-ASSIST scores  > 4); depression (CESD-10 scores ≥10); and other PrEP-relevant factors. The primary  outcome, PrEP nonadherence, entailed missing one or more PrEP doses over the past 4  days. A linear-by-linear test of association assessed whether increasing severity of  alcohol use (i.e., based on AUDIT categories) was linked to a greater occurrence of  PrEP nonadherence. Univariate logistic regression was employed to determine factors  associated with PrEP nonadherence, and factors demonstrating univariate associations  at the p < .10 significance level were included in a multivariate logistic  regression model. Additive and interactive effects involving key significant factors  were assessed through logistic regression to evaluate potential syndemic-focused  associations. <br><br>RESULTS: A total of 141 gbMSM (Mean age = 37.9, white = 63.1%)  completed the e-survey. Hazardous/harmful drinking (31.9%), moderate/high risk  substance use (43.3%), and depression (23.7%) were common; and one in five  participants (19.9%) reported PrEP nonadherence. Increasing alcohol use level was  significantly associated with a greater likelihood of nonadherence (i.e., 15.6,  25.0, and 44.4% of low-risk, hazardous, and harmful drinkers reported nonadherence,  respectively (χ(2)(1) = 4.79, p = .029)). Multivariate logistic regression  demonstrated that harmful alcohol use (AOR = 6.72, 95%CI = 1.49-30.33, p = .013) and  moderate/high risk cocaine use (AOR = 3.11, 95%CI = 1.01-9.59, p = .049)  independently predicted nonadherence. Furthermore, an additive association emerged,  wherein the likelihood of PrEP nonadherence was highest among those who were  hazardous/harmful drinkers and moderate/high risk cocaine users (OR = 2.25,  95%CI = 1.19-4.25, p = .013). Depression was not associated with nonadherence. <br><br>CONCLUSIONS: Findings highlight the need to integrate alcohol- and substance-focused  initiatives into PrEP care for gbMSM. Such initiatives, in turn, may help improve  PrEP adherence and reduce the potential for HIV acquisition among this group.<p /> <p>Language: en</p>",
language="en",
issn="1471-2458",
doi="10.1186/s12889-020-09883-z",
url="http://dx.doi.org/10.1186/s12889-020-09883-z"
}