The same lesson over and over: drugs alone will not get us to 90--90--90. (1st May 2020)

• Record Type: Journal Article
• Authors: Cohen, Jennifer; Pepperrell, Toby; Venter, Willem Daniel Francois
• Is Part Of: AIDS. Volume 34:Number 6(2020)
• Publication Date: 2020-05-01
• Subjects: adherence -- antiretroviral therapy -- HIV -- intention-to-treat -- social determinants of health; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000002494
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : N/A: Addressing social determinants of health (SDH) has far greater potential to improve the real-world effectiveness of HIV treatment than expensive, incremental changes in antiretroviral therapy. The ADVANCE study demonstrates that SDH is more impactful than medication regimen on health outcomes. Younger patients and unemployed patients experience heightened precarity, which can have pervasive effects on adherence and suppression. Enhanced adherence counselling can help socioeconomically precarious patients maintain suppression, but in order to improve treatment effectiveness and population health, we should move beyond the short-term solution of helping patients 'cope' with insecurity toward tackling the underlying factors that lead to precarity. Data on intention-to-treat populations are critical to this effort, yet medical researchers and publications continue to obscure the influence of SDH by focusing on per-protocol populations.