Impact of Beliefs and Social Determinants of Health on Treatment Outcomes in Hiv Infected Adults at Kenyatta National Hospital Outpatient Comprehensive Care Clinic

Abstract

BACKGROUND HIV remains a global epidemic affecting an estimated 37.7 million with 460,000 mortalities attributable to HIV-associated causes in 2020. Kenya has the third largest burden with 1.6 million persons living with HIV in 2019. The SDH (Social Determinants of Health) and beliefs in medicine determine 30-55% of disease outcomes. In the campaign to end the HIV epidemic it is imperative we define these factors and their role in determining health outcomes for HIV infected adults. METHODS: This study assessed SDH, beliefs in medicine and their effect on viral suppression in HIV-infected adults at KNH CCC clinic. This was a matched case-control study with matching on age (+/- 5 years) and gender. Cases had last viral load >/=1000 copies/ml, while controls had <1000 copies/ml. A ratio of 1:3 for cases:controls was used. We randomly recruited ambulatory HIV-infected adults (>/= 18 years at time of diagnosis) on anti-retroviral therapy for at least 6 months between August and September 2022. DATA MANAGEMENT: Data was collected using a structured checklist and self-administered questionnaires (SDH Questionnaire and Beliefs in Medicine Questionnaire). Sociodemographic and SDH variables were analysed and compared for cases and controls using univariate analysis and logistic resgression. Beliefs were analysed using Wilcoxon Signed rank test and regression analysis. Variables with p value </=0.05 from the regression analysis were deemed statistically significant. Comparative analysis was conducted using Chi square test for SDH and HIV suppression and odds ratios with 95% confidence interval were interpreted as measures of effect size. RESULTS: 340 participants were recruited (85 cases, 255 controls). 50.6% were female. Significant SDH in univariate analysis included housing stability (p-value 0.011), food security (p-value <0.001), current employment status (p-value 0.003), income meeting needs (p-value <0.001), access to health care (p-value 0.004) and personal safety (p-value 0.001). Cases had higher mean rank scores for beliefs in all subscales, however, only addiction and poison potential of medicines were not statistically significant. Significant variables following regression were poor access to health care with AOR 0.305 [0.106, 0.873], high school education with AOR 5.924[1.234, 28.446], self-employment with AOR 0.351[0.142, 0.868], severe food insecurity with AOR 5.578[1.173, 26.527] and lack of personal safety 6.678[1.174, 38.001]. Specific necessity AOR 2.52[1.51, 4.20] and specific concerns AOR 1.35[1.02, 1.85] subscales were significant. CONCLUSION: SDH and beliefs in medicine impact treatment outcomes in HIV-infected adults with increased risk of being unsuppressed in those with high school education, severe food insecurity, lack of personal safety and negative specific necessity-concerns beliefs.