Intimate partner violence and uptake and adherence of HIV treatment

Intimate partner violence and engagement in HIV care and treatment among women: a systematic review and meta-analysis.

Hatcher AM, Smout EM, Turan JM, Christofides N, Stockl H. AIDS. 2015 Sep 5. [Epub ahead of print]

Objective: We aimed to estimate the odds of engagement in HIV care and treatment among HIV-positive women reporting intimate partner violence (IPV).

Design: We systematically reviewed the literature on the association between IPV and engagement in care. Data sources included searches of electronic databases (PubMed, Web of Science, CINAHL and PsychoInfo), hand searches and citation tracking.

Methods: Two reviewers screened 757 full-text articles, extracted data and independently appraised study quality. Included studies were peer-reviewed and assessed IPV alongside engagement in care outcomes: antiretroviral treatment (ART) use; self-reported ART adherence; viral suppression; retention in HIV care. Odds ratios (ORs) were pooled using random effects meta-analysis.

Results: Thirteen cross-sectional studies among HIV-positive women were included. Measurement of IPV varied, with most studies defining a 'case' as any history of physical and/or sexual IPV. Meta-analysis of five studies showed IPV to be significantly associated with lower ART use [OR 0.79, 95% confidence interval (95% CI) 0.64-0.97]. IPV was associated with poorer self-reported ART adherence in seven studies (OR 0.48, 95% CI 0.30-0.75) and lower odds of viral load suppression in seven studies (OR 0.64, 95% CI 0.46-0.90). Lack of longitudinal data and measurement considerations should temper interpretation of these results.

Conclusion: IPV is associated with lower ART use, half the odds of self-reported ART adherence and significantly worsened viral suppression among women. To ensure the health of HIV-positive women, it is essential for clinical programmes to address conditions that impact engagement in care and treatment. IPV is one such condition, and its association with declines in ART use and adherence requires urgent attention.

Abstract access  [1]

Editor’s notes: Intimate partner violence (IPV) is prevalent globally (30%). It has been associated with HIV infection and also with progression to AIDS among women living with HIV. However it is unclear how intimate partner violence may impact on HIV-associated health. This study examined associations between violence exposure and uptake of HIV treatment and care services. The authors conducted a systematic review and meta-analyses. From an initial search of 621 studies, 13 were included in these analyses: 12 were conducted in the United States of America and one in Haiti. All were cross-sectional. Measurement of intimate partner violence varied from a single question to validated scales. Some 11 measured lifetime IPV and two measured recent intimate partner violence, in the past 12 months.

Meta-analysis suggests intimate partner violence is associated with significantly lower odds of (i) current ART use (ii) self-reported adherence and (iii) worsened viral load suppression. There was insufficient data to measure retention in HIV care. These analyses suggest that uptake and adherence to ART is a key pathway through which intimate partner violence may negatively influence HIV-associated health of women. Further research is necessary, in low and middle income settings, and among key populations. Future studies should develop and test programmes to address intimate partner violence within HIV clinical care. 

Latin America [10], Northern America [11]
Haiti [12], United States of America [13]
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