Medical chart-reported alcohol consumption, substance use, and mental health issues in association with HIV pre-exposure prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men

• Published in: BMC public health 2024-12, Vol.24 (1), p.3487-12
• Main Authors: Shuper, Paul A, Joharchi, Narges, Varatharajan, Thepikaa, Bogoch, Isaac I, Loutfy, Mona, El-Helou, Philippe, Giolma, Kevin, Woodward, Kevin, Rehm, Jürgen
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Alcohol; Alcohol Drinking - epidemiology; Alcohol Drinking - psychology; Behavior; Club drugs; Drinking of alcoholic beverages; Drug therapy; Gay men; Health aspects; HIV (Viruses); HIV infection; HIV Infections - prevention & control; HIV Infections - psychology; HIV pre-exposure prophylaxis (PrEP); Homosexuality, Male - psychology; Homosexuality, Male - statistics & numerical data; Humans; Male; Management; Medical Records; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Mental Disorders - epidemiology; Mental health; Middle Aged; MSM; MSM (Men who have sex with men); Ontario; Patient compliance; Pre-Exposure Prophylaxis - statistics & numerical data; Prevention; Psychological aspects; Retrospective Studies; Risk factors; Sexual and Gender Minorities - psychology; Sexual and Gender Minorities - statistics & numerical data; Substance abuse; Substance use; Substance-Related Disorders - epidemiology; Young Adult
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-20934-7

Although some evidence suggests that alcohol, substance use, and mental health issues diminish adherence to HIV Pre-Exposure Prophylaxis (PrEP) among gay, bisexual, and other men-who-have-sex-with-men (gbMSM), findings are somewhat inconsistent and have primarily derived from studies involving non-random samples. Medical chart extraction can provide unique insight by in part surmounting sampling-related limitations, as data for entire PrEP clinic populations can be examined. Our investigation entailed comprehensive chart extraction to assess the extent to which chart-reported alcohol, substance use, and mental health issues were associated with chart-reported PrEP nonadherence. Data from medical charts of gbMSM at two PrEP clinics in Toronto, Canada were extracted for a retrospective 12-month period (02/2018-01/2019). Charts were reviewed for all patients who were 1) ≥ 18 years old; 2) gbMSM; 3) prescribed PrEP ≥ 3 months, and 4) not in a PrEP-related drug trial. Information regarding PrEP, alcohol, substance use, mental health, and sexual behavior was extracted. PrEP adherence was classified in terms of (1) any reported nonadherence, and (2) 'suboptimal adherence,' reflecting nonadherence patterns indicative of insufficient pharmacological protection from HIV. Multivariate logistic regression was employed to identify factors associated with adherence outcomes. Data were extracted from 4,292 clinic visits among 501 eligible patients (age: M = 39.1; duration on PrEP: M = 17.4 months; daily PrEP regimen = 93.8%). Hazardous/harmful drinking, club drug use, and mental health issues were reported among 8.8%, 22.2%, and 26.1% of patients, respectively. Any nonadherence and suboptimal adherence were reported among 37.5% and 12.4% of patients, respectively. Factors significantly associated with any nonadherence included age