Effects of the SAVA syndemic-related factors on viral suppression of HIV women of color
METHODS: Data are from the cross-site evaluation of the Health Resources and Services Administration-funded Special Programs of National Significance initiative designed to engage and retain WoC in HIV care. A standardized multi-site baseline survey was employed and matched with chart abstraction data. Women were included if they had a viral load test within 90 days of the baseline survey (implying the receipt of some level of HIV care). Generalized estimating equations were used to explore associations between the psychosocial/health variables on viral suppression (y/n) while accounting for covariates and clustering of women by site. Models included the dichotomous predictor variables frequent mental distress (≥14 days of symptoms/month), substance abuse, binge alcohol use, sexual risk-taking behaviors, and intimate partner violence, controlling for demographic variables.
RESULTS: Data for 563 HIV+ WoC were analyzed and just under half (n=260) were virally suppressed. Higher values on the SAVA score (0 to 6) were associated with reduced risk of viral suppression; risk ratio (RR) = 0.88, 95% confidence interval (95% CI): 0.81, 0.96. The observed association was slightly attenuated following adjustment for covariates. Results from models including SAVA variable interactions indicate several of the relationships are on the multiplicative scale (p<0.10).
CONCLUSIONS: SAVA-related factors, in isolation and as part of a syndemic scale, were negatively associated with viral suppression. The presence of multiplicative / synergistic effects suggest that the syndemic approach may be a viable framework for predicting HIV clinical outcomes among this population.