Abstract

Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.

Original languageEnglish
Article number870
JournalBMC Public Health
Volume18
Issue number1
DOIs
Publication statusPublished - Jul 13 2018

Fingerprint

Italy
HIV
Therapeutics
Demography
RNA
Sex Factors
CD4 Lymphocyte Count
Internship and Residency
Ethnic Groups
HIV Infections
Multivariate Analysis
Students
Health

Keywords

  • Antiretroviral therapy
  • HIV
  • ICONA
  • Social determinants

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy. / ICONA Foundation Study group.

In: BMC Public Health, Vol. 18, No. 1, 870, 13.07.2018.

Research output: Contribution to journalArticle

@article{f86fe8ca28354e2fb1bb7c0c3931620d,
title = "Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy",
abstract = "Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART na{\"i}ve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82{\%} males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5{\%}) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.",
keywords = "Antiretroviral therapy, HIV, ICONA, Social determinants",
author = "{ICONA Foundation Study group} and Annalisa Saracino and Mauro Zaccarelli and P. Lorenzini and Alessandra Bandera and Giulia Marchetti and Francesco Castelli and Andrea Gori and E. Girardi and Cristina Mussini and Adriana Ammassari and M. Moroni and A. Antinori and M. Galli and G. Ippolito and A. Lazzarin and Perno, {C. F.} and A. Antinori and A. Castagna and E. Girardi and Adriana Ammassari and A. Antinori and A. Cingolani and A. Castagna and A. Cingolani and P. Cinque and {De Luca}, A. and E. Girardi and N. Gianotti and A. Gori and A. Saracino and L. Galli and P. Lorenzini and C. Viscoli and R. Piscopo and Castelli, {A. P.} and M. Galli and A. Lazzarin and A. Castagna and A. Gori and Guida, {M. G.} and G. Magnani and A. Antinori and E. Nicastri and R. Acinapura and M. Capozzi and R. Libertone and Mauro Zaccarelli and Mura, {M. S.} and {De Luca}, A. and M. Sciandra",
year = "2018",
month = "7",
day = "13",
doi = "10.1186/s12889-018-5804-z",
language = "English",
volume = "18",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

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TY - JOUR

T1 - Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

AU - ICONA Foundation Study group

AU - Saracino, Annalisa

AU - Zaccarelli, Mauro

AU - Lorenzini, P.

AU - Bandera, Alessandra

AU - Marchetti, Giulia

AU - Castelli, Francesco

AU - Gori, Andrea

AU - Girardi, E.

AU - Mussini, Cristina

AU - Ammassari, Adriana

AU - Moroni, M.

AU - Antinori, A.

AU - Galli, M.

AU - Ippolito, G.

AU - Lazzarin, A.

AU - Perno, C. F.

AU - Antinori, A.

AU - Castagna, A.

AU - Girardi, E.

AU - Ammassari, Adriana

AU - Antinori, A.

AU - Cingolani, A.

AU - Castagna, A.

AU - Cingolani, A.

AU - Cinque, P.

AU - De Luca, A.

AU - Girardi, E.

AU - Gianotti, N.

AU - Gori, A.

AU - Saracino, A.

AU - Galli, L.

AU - Lorenzini, P.

AU - Viscoli, C.

AU - Piscopo, R.

AU - Castelli, A. P.

AU - Galli, M.

AU - Lazzarin, A.

AU - Castagna, A.

AU - Gori, A.

AU - Guida, M. G.

AU - Magnani, G.

AU - Antinori, A.

AU - Nicastri, E.

AU - Acinapura, R.

AU - Capozzi, M.

AU - Libertone, R.

AU - Zaccarelli, Mauro

AU - Mura, M. S.

AU - De Luca, A.

AU - Sciandra, M.

PY - 2018/7/13

Y1 - 2018/7/13

N2 - Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.

AB - Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.

KW - Antiretroviral therapy

KW - HIV

KW - ICONA

KW - Social determinants

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