Dissertation/Thesis Abstract

Syndemic Approach to the Social Determinants of Hepatitis C Infection in a Sample of HIV-Positive People Who Inject Drugs in Puerto Rico
by Maisonet-Alejandro, Mariela, D.P.H., University of Puerto Rico Medical Sciences (Puerto Rico), 2018, 162; 10841370
Abstract (Summary)

Syndemic analysis has been used to explain disease interactions and comorbidities in public health research. However, its application to the Social Determinants of Health (SDH) framework, particularly its application to co-occurring contextual determinants that play a role in Hepatitis C virus (HCV) acquirement among HIV positive people who inject drugs (PWID), has yet to be explored. The research objective was to examine the associations, the syndemic exposure and the syndemic interaction between multiple co-occurring contextual determinants, specifically low educational attainment, homelessness and history of incarceration, and Hepatitis C infection in a sample of HIV-positive participants who use injectable drugs in Puerto Rico.

A secondary data analysis using univariate and bivariate approaches were used to assess factors independently associated to HCV infection. Logistic regression analyses were used to assess burden of disease through the additivity and interaction of cumulative syndemic conditions and HIV/HCV coinfection status among 272 HIV-positive injecting drug users in Puerto Rico. In bivariate analyses, HIV/HCV coinfection was significantly associated with history of incarceration (OR = 2.16, 95% CI [0.97–4.84]).

In multivariate analyses, the adjusted logistic regression model suggested that men were more likely to be coinfected than women (aOR = 3.18, 95% CI [1.20–8.39]), that homosexual participants were less likely to be coinfected than heterosexual participants, (aOR = 0.20, 95% CI [0.05–0.85]), and that participants who had never had an HIV Primary Care visit were more likely to be coinfected than participants who had their last HIV Primary Care visit 0-3 months prior to the interview (aOR = 5.04, 95% CI [1.09–23.27]). In the disease additivity assessment, the unadjusted and adjusted logistic regression models indicated statistically significant additive (p < 0.05) ORs across the syndemic count scores. In the interaction assessment, all observed joint effects have a value below zero, which suggests that there is a negative interaction of the two effects above that of the independent effects. Specifically, the potential negative effects of one syndemic factor could be worse than the effect of two syndemic factors combined.

Findings support significant associations between syndemic factors low educational attainment, homelessness and history of incarceration and HIV/HCV coinfection within this sample of Puerto Rican injecting drug users. The results of the syndemic exposure assessment support the proposition that syndemic factors are additively associated with HIV/HCV coinfection. Interventions aimed at increasing HIV care adherence, reduction of injecting drug use and unsafe tattooing practices in prisons among male injecting drug users may have an impact in reducing rates of HCV infection. Further analyses related to co-occurring social determinants of health among PWID and HCV infection are needed to assess the interplay between syndemic conditions and disease interaction.

Indexing (document details)
Advisor: Rodriguez, Carlos E.
Commitee: Marzan, Melissa, Santana, Jorge L.
School: University of Puerto Rico Medical Sciences (Puerto Rico)
Department: Public Health
School Location: United States -- Puerto Rico
Source: DAI-A 79/12(E), Dissertation Abstracts International
Subjects: Social research, Caribbean Studies, Latin American Studies, Virology, Epidemiology
Keywords: HIV/HCV coinfection, Hepatitis C, Injection drug use, Puerto Rico, Social determinants of health, Syndemics
Publication Number: 10841370
ISBN: 978-0-438-19200-3
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