Table 3.
Factors associated with perceived quality of HIV care a among HIV‐positive PWID receiving OAT at seven sites in Ukraine: ordinal regression analysis, n = 191
| Crude OR (95% CI) | Adjusted OR (95% CI) | |
|---|---|---|
| Co‐located OAT and ART sites (ref. OAT only sites) | 3.03 (1.78, 5.21) | 4.13 (2.31, 7.54) |
| Stigma | ||
| HIV stigma score | 1.01 (0.99, 1.03) | – |
| Substance use stigma score | 0.99 (0.97, 1.01) | – |
| Dual stigma b (ref. low/medium HIV and substance use stigma) | ||
| High HIV and substance use stigma | 1.05 (0.49, 2.28) | 1.28 (0.57, 2.95) |
| High HIV stigma only | 0.89 (0.42, 1.88) | 0.65 (0.28, 1.44) |
| High substance use stigma only | 0.43 (0.19, 0.94) | 0.44 (0.18, 1.01) |
| Demographical characteristics | ||
| Age, years | 1.06 (1.02, 1.10) | 1.04 (1.00, 1.08) |
| Male gender (ref. female) | 1.00 (0.55, 1.82) | ref. |
| Married/have regular partner (ref. single, never married, divorced, separated or widowed) | 1.01 (0.60, 1.70) | – |
| Household size, persons | 0.94 (0.81, 1.10) | – |
| Living with children under 18 years (ref. no) | 0.69 (0.39, 1.22) | – |
| High school or less education (ref. higher education) | 1.36 (0.68, 2.73) | – |
| Vocational education (ref. higher education) | 1.25 (0.63, 2.52) | – |
| Unemployed including housewives and students (ref. full or part‐time employment) | 1.35 (0.80, 2.27) | – |
| Personal monthly income above the median: >1667 UAH c (ref. median or below) | 1.00 (1.00, 1.00) | – |
| History of incarceration (ref. no) | 1.51 (0.88, 2.61) | – |
| Behavioral characteristics | ||
| Any illicit drug use during the last 30 days (ref. no) | 0.61 (0.36, 1.01) | – |
| 1 sexual partner during the last 12 months (anal/vaginal sex) (ref. no partners) | 1.16 (0.59, 2.24) | – |
| ≥2 sexual partners during the last 12 months (anal/vaginal sex) (ref. no partners) | 0.75 (0.32, 1.72) | – |
| Condomless sex during the last 12 months (anal/vaginal) (ref. no) | 1.22 (0.72, 2.07) | – |
| History of selling sex (ref. no) | 0.91 (0.31, 2.72) | – |
| Everyday or occasional smoker (ref. smoked before or never smoked) | 0.36 (0.09, 1.22) | – |
| AUDIT‐C score | 0.84 (0.76, 0.94) | 0.86 (0.76, 0.96) |
| Clinical characteristics | ||
| Time since first HIV‐positive test result, years | 1.08 (1.04, 1.13) | 1.08 (1.03, 1.13) |
| CD4 count | 1.00 (1.00, 1.00) | ref. |
| History of TB (ref. no) | 2.94 (1.59, 5.55) | 2.93 (1.50, 5.87) |
| Diagnosed with HCV (ref. no) | 1.85 (0.82, 4.20) | – |
| SF12v2 physical health T‐score | 0.98 (0.95, 1.00) | – |
| SF12v2 mental health T‐score | 1.01 (0.98, 1.04) | – |
| Ever attempted suicide (ref. no) d | 0.52 (0.29, 0.91) | – |
| OAT drug: Methadone (ref. Buprenorphine) d | 0.71 (0.29, 0.91) | – |
| OAT duration, years | 1.11 (1.00, 1.23) | – |
| Attitudes | ||
| Perceived accessibility of the healthcare facility | 1.01 (1.00, 1.03) | – |
| Perceived user‐friendliness of the healthcare facility | 1.01 (1.00, 1.03) | – |
| Social support score | 1.00 (0.99, 1.01) | – |
| Receipt of services at non‐governmental organization (ref. no) | 1.72 (0.97, 3.05) | – |
Values in bold indicate statistically significant associations.
ART, antiretroviral treatment; AUDIT‐C, The Alcohol Use Disorders Identification Test, short version; CI, confidence interval; HCV, Hepatitis C Virus; OAT, opioid agonist therapy; OR, odds ratio; PWID, people who inject drugs; SF12v2, Short Form Health Survey questionnaire, version 2; TB, tuberculosis; UAH, Ukrainian Hryvnias.
HIV Care Quality Index (HCQI) was categorized by quartiles (<70, 70‐79, 80‐89, ≥90 out of 100 points).
High stigma score was defined as a score above the 75th percentile and low/medium stigma as a score below the 75th percentile.
1U.S. dollar = 26 UAH.
Due to the limited sample size, history of suicide and type of OAT drug were not included in the multivariable model despite their significant association with HCQI in unadjusted analysis.