Material security and adherence to antiretroviral therapy (ART) among HIV-positive people who use illicit drugs.

OBJECTIVE To examine the relationship between poverty, operationalized using a novel material security measure, and adherence to antiretroviral therapy (ART) among people who use illicit drugs (PWUD) in a context of universal access to HIV care. DESIGN We analyzed data from a community-recruited prospective cohort in Vancouver, Canada (n = 623), from 2014 - 2017. METHODS We used multivariable generalized mixed-effects analyses to estimate longitudinal factors associated with mean material security score. We then estimated the association between achieving ≥ 95% adherence to ART and overall mean material score, as well as mean score for three factors derived from a factor analysis. The three factors structure, employed in the current analyses, were Factor 1 (basic needs); Factor 2 (housing-related variables) and Factor 3 (economic resources). RESULTS Recent incarceration [β-coefficient (β) = -0.176, 95% Confidence Interval [95%CI]: -0.288, -0.063), unmet health needs (β = -0.110, 95% CI: -0.178, -0.042), unmet social service needs (β = -0.264, 95% CI: -0.336, -0.193) and having access to social services (β= -0.102, 95% CI: -0.1586, -0.0465) were among the factors associated with lower material security scores. Contrary to expectations that low levels of material security in this population would lead to poor ART adherence, we did not observe a significant relationship between adherence and overall material security score, as well as for each factor individually. CONCLUSION Our findings highlight the potentially important role of no-cost, universal access to HIV prevention and treatment, in mitigating the impact of socioeconomic disadvantage on ART adherence.