The Impact of COVID-19 Stress on ART Adherence and Unsuppressed Viral Loads in People Living with HIV in Western Washington

Thesis (Master's)--University of Washington, 2021University of WashingtonAbstract The Impact of COVID-19 Stress on ART Adherence and Unsuppressed Viral Loads in People Living with HIV in Western Washington Francis A. Slaughter Chair of the Supervisory Committee: Susan Graham Department of Global Health Background: While current research finds that people living with HIV (PLWH) with suppressed HIV viral loads have similar likelihood of hospitalization and death due to COVID-19 as the general population, COVID-19 stress may lead to decreased ability for PLWH to engage in care. Personal buffers, such as social support and identity characteristics, including US citizenship or white race, may potentially moderate stress from COVID-19. The objective of this study was to determine COVID-19 stress’s impact on key treatment outcomes among PLWH. Methods: We conducted a cross-sectional study consisting of a Computer-Assisted Personal Interview (CAPI) survey administered online to PLWH in Western Washington during the COVID-19 pandemic. Bivariable and multivariable logistic regressions were used to determine the association between COVID-19 stress and (1) self-reported HIV treatment adherence or (2) HIV viral suppression. Additionally, we sought to determine if US-born status, white race, or social support were moderators of the association between COVID-19 stress and either outcome. Results: Overall, 395 participants completed the CAPI survey during the collection period of August 1, 2020 to March 21, 2021. Thirty participants (8%) reported decreased ART adherence and 39 participants (12.7%) had unsuppressed viral loads during social distancing. There was a borderline-significant association between COVID-19 stress score and decreased adherence (unadjusted odds ratio [OR] 1.07, 95% confidence interval [CI]: 0.99 – 1.15). Interactions between COVID-19 stress score and each potential moderator (US-born status, white race, and social support) were not significant predictors of this outcome. There were no associations of either COVID-19 stress score (OR=1.04, 95% CI 0.98 – 1.12) or the interactions between COVID-19 stress score and each of the potential moderators with the outcome of unsuppressed viral load during social distancing. Conclusion: Overall, we found that despite stress about COVID-19, patients in Western Washington, for the most part, had good adherence to ART and were able to maintain viral suppression during the pandemic. This may be due, in part, to telemedicine and other accommodations clinics made due to social distancing to ensure access to care or to patients’ own resilience in the face of adversity