The Impact of Non-Antiretroviral Polypharmacy on the Continuity of Antiretroviral Therapy (ART) among HIV Patients

Improved survival achieved by many patients with HIV/AIDS has complicated their medical care as increasing numbers of co-morbidities leads to polypharmacy, increased pill burdens, and greater risks of drug–drug interactions potentially compromising antiretroviral treatment (ART). We examined the impact of non-antiretroviral polypharmacy on ART for all adults followed at the Southern Alberta Clinic, Calgary, Canada. Polypharmacy was defined as ≥5 daily medications. 

We compared the impact of polypharmacy on continuous (i.e., remaining on same ART for ≥6 months) vs. non-continuous (i.e., discontinuing or switching ART) ART dosing frequency, number of ART pills, number of non-ART medications, and age. Of 1190 (89.5%) patients on ART, 95% were on three-drug regimens, 63.9% on QD ART, and 62% ≥3 ART pills daily; 32.2% were experiencing polypharmacy. Polypharmacy was associated with lower CD4, AIDS, >180 months living with HIV, higher numbers of ART pills, and older age; 32.1% stopped or switched ART. Polypharmacy increased the risk for non-continuous ART (36.8% vs. 30.0%; p < 0.01). Non-continuous ART increased with daily ART pill count but not increased age. Non-adherence and adverse effects accounted for the majority of non-continuous ART. 

We found a strong association between polypharmacy and non-continuous ART, potentially leading to effective ART being compromised. Collaborative approaches are needed to anticipate the negative impacts of polypharmacy.

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By: Hartmut B. Krentz, PhD,^1,2 and M. John Gill, MB, ChB^1,2

¹Southern Alberta Clinic, Calgary, Alberta, Canada.

²Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

  

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Primary Healthcare Needs & Barriers to Care among Calgary’s Homeless Populations

Despite Canada’s universal healthcare system, significant barriers impede individuals experiencing homelessness from accessing health services. Furthermore, there is a paucity in the qualitative literature describing how Canadians experiencing homelessness access health care services. Our objective was to qualitatively explore perceived healthcare needs and barriers among individuals experiencing homelessness in one large Canadian city – Calgary, Alberta.

We conducted a qualitative descriptive study that included open-ended interviews and focus groups with a variety of stakeholders who are involved in healthcare among Calgary’s homeless populations. These included individuals experiencing homelessness (n = 11) as well as employees from several healthcare service providers for those experiencing homelessness (n = 11). Transcripts from these interviews were thematically analyzed by two analysts.

Stakeholder interviews yielded several pervasive themes surrounding the health care needs of the homeless and barriers to accessing care. Some of the primary health care needs which were identified included mental health, addictions, and allied health as well as care that addresses the social determinants of health. Notably, it was difficult for many stakeholders to pinpoint specific health care priorities, as they identified that the health care needs among Calgary’s homeless populations are diverse and complex, often even describing the needs as overwhelming. Types of barriers to primary care that were identified by stakeholders included: emotional, educational, geographical, financial and structural barriers, as well as discrimination.

Our findings highlight the diverse primary health care needs of Calgary’s homeless populations. Despite the fact that Canada has a universal publicly funded health care system, individuals experiencing homelessness face significant barriers in accessing primary care.

Full article at: http://goo.gl/bShd8n

By: David J. T. Campbell^1*, Braden G. O’Neill², Katherine Gibson³ and Wilfreda E. Thurston⁴

¹Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Room G236 Health Sciences Centre, 3330 Hospital Dr NW, Calgary T2N 1 N4, AB, Canada

²Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

³1 Canadian Field Hospital, Canadian Armed Forces, Petawawa, ON, Canada

⁴Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

  

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A Pilot Study of a Group-Based HIV and STI Prevention Intervention for Lesbian, Bisexual, Queer, and Other Women Who Have Sex with Women in Canada

Limited research has evaluated interventions to reduce HIV and sexually transmitted infection (STI) vulnerability among lesbian, bisexual, and queer (LBQ) women, and other women who have sex with women. The Queer Women Conversations (QWC) study examined the effectiveness of a group-based psycho-educational HIV/STI intervention with LBQ women in Toronto and Calgary, Canada. 

We conducted a nonrandomized cohort pilot study. Participants completed a pre-test, post-test, and 6-week follow-up. The primary outcome was sexual risk practices, while secondary objectives included intrapersonal (self-esteem, STI knowledge, resilient coping, depression), interpersonal (safer sex self-efficacy), community (community connectedness, social support), and structural (sexual stigma, access to healthcare) factors. 

The study was registered at http://clinicaltrials.gov. Forty-four women (mean age 28.7 years) participated in a weekend retreat consisting of six consecutive sessions tailored for LBQ women. Sessions covered a range of topics addressing behavioral and social-structural determinants of HIV/STI risk, including STI information, safer sex negotiation skills, and addressing sexual stigma. 

Adjusted for socio-demographic characteristics, sexual risk practices, barrier use self-efficacy, STI knowledge, and sexual stigma scores showed statistically significant changes 6 weeks post-intervention. Initial increases in safer sex self-efficacy, social support, and community connectedness were not sustained at 6-week follow up, highlighting the need for booster sessions or alternative approaches to address social factors. 

Study results may inform HIV/STI prevention interventions, sexual health care provision, and support services tailored for LBQ women.

Purchase full article at: http://goo.gl/Bl3rFo

By: Logie CH1,2, Lacombe-Duncan A1, Weaver J1, Navia D3, Este D4.

• 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
• 2Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
• 3Department of Anthropology, University of Calgary, Calgary, Alberta, Canada.
• 4Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada.

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