Date of Award

January 2016

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Frederick L. Altice

Abstract

Objective: To examine neurocognitive impairment (NCI) and its association with antiretroviral therapy (ART) medication adherence among HIV-infected men who have sex with men (MSM) and transgender women (TGW) in Lima, Peru.

Methods: A cross-sectional survey assessed 313 HIV-infected Peruvian MSM and TGW prescribed ART using a computer-assisted survey instrument to examine NCI and its association with optimal ART adherence, defined as taking ≥90% of prescribed medications. The survey included demographic characteristics and standardized measures for drug and alcohol use disorders, depression, and other factors associated with non-adherence.

Results: An exploratory factor analysis was conducted to optimize an NCI self-report scale for use with HIV-infected MSM and TGW in Peru. Participant scores indicated moderate NCI and 131 (41.7%) and 134 (42.5%) participants met criteria for an alcohol use disorder (AUD) or depression, respectively, 33 (10.5%) reported recent recreational drug use, and 81 (26.3%) had low health literacy. Overall, 268 (85.9%) met criteria for self-reported optimal ART adherence. Psychomotor NCI subscale score (AOR=0.534; 95% CI=0.317-0.931), having an AUD (AOR=0.203; 95% CI=0.063-0.655), identifying as transgender (AOR=0.175 95% CI=0.032-0.954), and low health literacy (AOR=0.253 95% CI=0.077-0.831) were independently and negatively correlated with optimal ART adherence. Income of minimum wage or higher was independently and positively correlated with optimal ART adherence. Depression was significant only in the bivariate analysis, but did not remain significant after controlling for other covariates.

Conclusions: NCI is prevalent among Peruvian HIV-infected MSM and TGW and psychomotor impairment is independently correlated with suboptimal ART adherence. Our findings support the need to screen and treat or accommodate NCI in order to improve ART adherence among HIV-infected MSM/TGW.

Comments

This is an Open Access Thesis.

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