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AIDS and Behavior (2019) 23:649–660
https://doi.org/10.1007/s10461-019-02415-w
ORIGINAL PAPER
The Longitudinal Eects ofNon‑injection Substance Use onSustained
HIV Viral Load Undetectability Among MSM andHeterosexual Men
inBrazil andThailand: The Role ofART Adherence andDepressive
Symptoms (HPTN 063)
KiyomiTsuyuki1 · StevenJ.Shoptaw2· YusufRansome3· GordonChau4· CarlosE.Rodriguez‑Diaz5·
RuthK.Friedman6· KriengkraiSrithanaviboonchai7,8· SueLi4· MatthewJ.Mimiaga9· KennethH.Mayer10·
StevenA.Safren11
Published online: 6 February 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
The effect of non-injection substance use on HIV viral load (VL) is understudied in international settings. Data are from
HPTN063, a longitudinal observational study of HIV-infected individuals in Brazil, Thailand, and Zambia, with focus on
men with VL data (Brazil = 146; Thailand = 159). Generalized linear mixed models (GLMM) assessed whether non-injection
substance use (stimulants, cannabis, alcohol, polysubstance) was associated with VL undetectability. ART adherence and
depressive symptoms were examined as mediators of the association. In Thailand, substance use was not significantly asso-
ciated with VL undetectability or ART adherence, but alcohol misuse among MSM was associated with increased odds of
depression (AOR = 2.75; 95% CI 1.20, 6.32, p = 0.02). In Brazil, alcohol misuse by MSM was associated with decreased
odds of undetectable VL (AOR = 0.34; 95% CI 0.13, 0.92, p = 0.03). Polysubstance use by heterosexual men in Brazil was
associated with decreased odds of ART adherence (AOR = 0.25; 95% CI 0.08, 0.78, p = 0.02). VL suppression appears attain-
able among non-injection substance users. Substance use interventions among HIV-positive men should address depression,
adherence, and VL undetectability.
Keywords Substance use· HIV· Depression· Adherence· Undetectable viral load
* Kiyomi Tsuyuki
ktsuyuki@gmail.com
1 Division ofInfectious Diseases andGlobal Public Health,
Department ofMedicine, University ofCalifornia, San
Diego (UCSD), 9500 Gilman Drive, MC 0507, La Jolla,
SanDiego, CA92093-0507, USA
2 David Geffen School ofMedicine, Department ofFamily
Medicine, University ofCalifornia, Los Angeles (UCLA),
LosAngeles, CA, USA
3 Harvard T.H. Chan School ofPublic Health, Boston, MA,
USA
4 Statistical Center forHIV/AIDS Research andPrevention
(SCHARP), Fred Hutchinson Cancer Research Center,
Seattle, WA, USA
5 University ofPuerto Rico, Medical Sciences Campus,
SanJuan, PuertoRico
6 Instituto de Pesquisa Clinica Evandro Chagas, RiodeJaneiro,
Brazil
7 Faculty ofMedicine, Chiang Mai University, Muang District,
ChiangMai, Thailand
8 Research Institute forHealth Sciences, Chiang Mai
University, Muang District, ChiangMai, Thailand
9 Center forHealth Equity Research, Brown University,
Providence, RI, USA
10 The Fenway Institute, Fenway Health, Boston, MA, USA
11 Department ofPsychology, University ofMiami,
CoralGables, FL, USA
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