Assessing Relationships Between Adverse Childhood Experiences and Viral Suppression Among Persons Living with HIV in Washington State

Thesis (Master's)--University of Washington, 2022Background: Adverse childhood experiences (ACEs) have been linked to a variety of negative health outcomes in adulthood and have been recognized as a hurdle to participating in HIV care. However, few studies have examined the cumulative impact that different types of childhood trauma have on HIV care engagement and HIV outcomes. To address this gap, this analysis sought to characterize the relationship between various types of childhood trauma, including abuse and household dysfunction trauma, and viral suppression among persons living with HIV. Methods: This cross-sectional study utilized surveillance data from the 2018-2019 Medical Monitoring Project (MMP) cycle in Washington State. We conducted single-variable and multi-variable logistic regression analyses to quantify the impact that number of ACEs and the type of ACEs experienced has on viral suppression. We also used Poisson regression analyses to assess the relationship between ACEs and health related quality of life (HRQOL) among persons living with HIV. Results: Among 328 participants, 86.8% of all individuals reported they had experienced at least 1 ACE and 39.5% reported they had experienced 4 or more. Adjusting for demographic characteristics, we did not find evidence of significant differences in odds of achieving cross-sectional viral suppression among individuals who had experienced 1, 2, 3, or 4+ ACEs, as compared to individuals who did not experience any ACEs (1: Adjusted OR= 0.65, 95% CI= 0.13, 3.25 | 2: Adjusted OR= 1.49, 95% CI= 0.20, 10.89 | 3: Adjusted OR= 0.14, 95% CI= 0.03, 0.69 | 4+: Adjusted OR= 0.49, 95% CI= 0.12, 2.09). A higher number of ACEs was significantly associated with poorer self-reported HRQOL (1: Adjusted RR= 1.53, 95% CI= 0.69, 3.38 | 2: Adjusted RR= 2.87, 95% CI= 1.35, 6.09 | 3: Adjusted RR= 2.85, 95% CI= 1.35, 6.02 | 4+: Adjusted RR= 3.19, 95% CI= 1.59, 6.40). Conclusion: We found that the prevalence of adverse childhood experiences was high among our study population. We did not find significant evidence of associations between adverse childhood experiences and viral suppression. However, we did find that a higher number of self-reported ACEs was significantly associated with poorer HRQOL. These results are important considerations in establishing trauma-informed systems for improving quality of life, health outcomes, and care engagement among persons living with HIV