Intimate partner violence and engagement in HIV care and treatment among women: A systematic review and meta-analysis
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1 Intimate partner violence and engagement in HIV care and treatment among women: A systematic review and meta-analysis Abigail M Hatcher Elizabeth M Smout Janet M Turan Nicola Christofides Heidi Stöckl
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4 Medical factors Daily dosing frequency Pill burden Time since HIV diagnosis Individual factors Current substance use Depressive symptoms Household/Social factors Financial constraints Food insecurity HIV stigma Social Support
5 An estimated 30% of women around the world experience intimate partner violence (IPV) in their lifetime
6 Clinical samples suggest that in the U.S., 68-95% of HIV-positive women experience IPV in their lifetime (1-5) 1. Cohen (2000) AJPH 2. Brady (2002) AIDS Pat Care STD 3. Vlahov (1998) Aids Beh 4. Sowell (2002) JANAC 5. Borwein (2013) AIDS Care
7 Li (2014) JIAS IPV is associated with incident HIV infection among women
8 Preliminary evidence suggests a link between IPV and engagement in care Anticipated IPV is associated with refusing HIV testing (1, 2) Anticipated violence lengthens time to linkage to care (3) History of physical or sexual IPV worsens health outcomes: virologic failure (4, 5) lower CD-4 counts (4) higher incidence of opportunistic infection (5, 6) greater risk of mortality (7) 1. Medley (2004) Bull WHO. 2. Turan (2011) AIDS Beh. 3. Hatcher (2012) AIDS Beh 4. Schafer (2012) AIDS Pat Care STDs 5. Nava (2011) 6. Liebshutz (2000) Arch Int Med 7. Weber (2012) AIDS Conf
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10 Study Characteristics n=13 studies Published recently ( ) All cross-sectional, with relatively small samples (median n=234) Even among those with men and women (n=4), we analyzed woman only 1. Blackstock (2015) AIDS Pat Care STDs 2. Blank (2015) AIDS Pat Care STDs 3. Ryerson Espino (2015) AIDS Pat Care STDs 4. Illangesekare (2012) Womens Health Issues 5. Kalokhe (2012) AIDS Pat Care STDs 6. Lopez (2010) AIDS Educ Prev 7. Malow (2013) Aids Beh 8. Ramachandran (2010) AIDS Care 9. Rose (2010) Psych Trauma 10. Schafer (2012) AIDS Pat Care STDs 11. Siemieniuk (2013) JAIDS 12. Sullivan (2015) AIDS Pat Care STDs 13. Trimble (2013) JANAC
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12 Retention studies (n=5) IPV IPV N.S. N.S. interruptions (>365 days) in clinical care a out of care in the past 12 months b self-reported medical care in the past 6 months c,d no show rate e a. Siemieniuk (2013) JAIDS b. Kalokhe (2012) AIDS Pat Care STDs c. Blackstock (2015) AIDS Pat Care STDs d. Blank (2015) AIDS Pat Care STDs e. Schafer (2012) AIDS Pat Care STDs
13 ART uptake studies (n=5) IPV Lower current ART use a,b N.S. Self-reported ART use c,d,e a. Kalokhe (2012) AIDS Pat Care STDs b. Ramachandran (2010) AIDS Care c. Siemieniuk (2013) JAIDS d. Illangesekare (2012) Womens Health Issues Blank e. Blank (2015) AIDS Pat Care STDs
14 Meta-analysis of studies examining association between IPV and current ART use (n=5) Hatcher (2015) AIDS
15 ART adherence studies (n=7) IPV IPV N.S. Lower self-reported adherence (MMAS a ; CAI b ) Lower physician-reported adherence c Self-reported ART use (ACTG d,e ; VAS f ) a. Trimble (2013) JANAC b. Blank (2015) AIDS Pat Care STDs c. Rose (2010) Psych Trauma d. Lopez (2010) AIDS Educ e. Ryerson Espino (2015) AIDS Pat Care STDs f. Malow (2013) Aids Beh
16 Meta-analysis of studies examining association between IPV and ART Adherence (n=6) Hatcher et al. (2015) AIDS
17 Viral suppression studies (n=7) IPV Lower viral suppression a,b,c N.S. Viral suppression d,e,f,g a. Siemieniuk (2013) JAIDS b. Rose (2010) Psych Trauma c. Ryerson Espino (2015) AIDS Pat Care STDs d. Blank (2015) AIDS Pat Care STDs e. Illangesekare (2012) Womens Health Issues f. Schafer (2012) AIDS Pat Care STDs g. Sullivan (2015) AIDS Pat Care STDs
18 Meta-analysis of studies examining association between IPV and Viral Suppression (n=7) Hatcher et al. (2015) AIDS
19 Gaps in the Evidence No longitudinal studies Inconsistencies with IPV measurement ART retention in care not feasible to measure meta-analytically Geographic skew
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21 Conclusion IPV reduces the odds of ART adherence among women Meta-analytic finding is consistent when adherence is measured by: self-reported adherence (OR=0.48, 95%CI ) viral load suppression (OR= %CI ) Effect size is greater than other factors regularly addressed in HIV clinical care: Substance use Depression Dosing and pill burden
22 What next? Clinical programs should address IPV within HIV care Guidelines already exist a,b HIV-specific interventions are starting to be developed c,d What about IPV HIV link other crucial populations? MSM Injecting drug users Female sex workers Adolescents a. WHO (2013) Clinical Guidelines b. Moyer (2013) Annals Intern Med c. Machtinger (2015) Womens Health d. Turan (2013) AIDS Res Tx
23 Acknowledgments Authors of primary studies who provided additional data University of Witwatersrand School of Public Health Interdisciplinary PhD program PLOS Early Career Travel Award Program Global Health Now Globalhealthnow.org
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Hatcher, AM; Smout, EM; Turan, JM; Christofides, N; Stckl, H (2015) Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis. AIDS (London,
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