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High Loneliness Score in Half of Ontario HIV
Cohort-Tied to Poor ART Adherence
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AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
Almost half of 1870 people in an Ontario HIV cohort had high scores on a loneliness scale, and people with higher loneliness scores were more likely to miss antiretroviral therapy (ART) doses [1]. These results came from a survey conducted during the height of the COVID pandemic, when lockdowns may have exacerbated loneliness in a group already prone to social isolation.
Ontario HIV Cohort Study (OCS) researchers defined loneliness as "a subjective experience that causes distress over the absence of social contact, belonging or a sense of being alienated." Plentiful research ties loneliness to mental health problems including depression, anxiety, self-harm, and suicidality.
To assess the degree of loneliness in people with HIV and gauge its impact on antiretroviral adherence, OCS investigators focused on this longitudinal cohort study, which has enrolled more than 8000 people since 1995 at 15 clinics across Ontario [2]. Participants complete interviewer-administered questionnaires every year.
About 2000 people completed questionnaires in 2020, when researchers added the 3-item UCLA Loneliness Scale to the questionnaire. Respondents can answer "hardly ever," "some of the time," or "often" to these questions:
1. How often do you feel that you lack companionship?
2. How often do you feel left out?
3. How often do you feel isolated from others?
Combined loneliness scores can range from 3 to 9, with 3-4 meaning a low loneliness level, 5-6 a medium level, and 7-9 a high level. Answers to questions on adherence let the researchers create two adherence categories: (1) never skipped a dose or skipped more than 3 months ago, (2) skipped recently-less than 3 months ago.
Through June 10, 2021, 1870 people completed the loneliness scale questions. Their age averaged 52.2 years, 22% identified themselves as women, 71% as men, and 7% as nonbinary. About two thirds were LGBQ (lesbian, gay, bisexual, queer) and one third heterosexual. While 60% were white, 22% were black, 2.5% indigenous people, and the rest some other race or ethnicity. Three quarters of respondents had HIV infection for more than 10 years, 61% were single, widowed, or divorced, 37% had an income below $20,000 per year, and 37% were born outside Canada.
Substantial proportions of respondents felt they lacked companionship often (19.6%) or some of the time (30.8%). Similar proportions felt left out often (13.2%) or some of the time (26.1%) or felt isolated from others often (17.9%) or some of the time (29.0%). Combining responses showed that 20.7% had a high loneliness score and 27.1% had a medium score. In other words nearly half of this HIV group had medium or high loneliness levels.
Contrary to what might be expected, only 29% of people in the oldest age group, 65 or older, fell into the high/medium loneliness category, compared 46% of the 50-64 group, 57% of the 35-49 group, and 55% of the under-35 group (P < 0.0001). People with an income below $20,000 yearly were more likely to have a medium or high loneliness score than people earning more (58% vs 42%, P < 0.0001). And single people had a medium or high loneliness score much more often than people with a spouse or partner (60.4% vs 28%, P < 0.0001). A higher proportion of people female than male at birth had medium or high loneliness scores (54% vs 46%, P = 0.01), but this difference could reflect men's well-known aversion to admitting depression or loneliness.
A proportional odds model picked out several independent predictors of loneliness at the following adjusted odds ratio (aOR) (and 95% confidence intervals [CI]):
Age younger than 65 compared with 65 or older:
- 50-64: aOR 2.18 (1.57 to 3.03)
- 35-49: aOR 3.18 (2.22 to 4.56)
- Under 35: aOR 2.84 (1.80 to 4.48)
Gross personal yearly income below $20,000: aOR 1.51 (1.23 to 1.85)
Harmful alcohol use: aOR 1.49 (1.08 to 2.07)
Being single: aOR 4.04 (3.26 to 5.00)
Nonmedicinal drug use: aOR 1.52 (1.13 to 2.06)
Female at birth: aOR 1.38 (1.06 to 1.79)
Being black rather than white (conferring lower odds): aOR 0.67 (0.5 to 0.89)
People who fell into the high loneliness bracket were more likely to skip their antiretroviral dose in the last 3 months than not to skip dosing (25.4% vs 17.5%), as were people in the medium loneliness cluster (30.5% vs 25.3%), but not in the low loneliness group (44.1% vs 57.2%) (P < 0.0001 overall). In an adjusted analysis, having a high mark on the loneliness scale (compared with a low mark) boosted odds of poor adherence about 40% (aOR 1.41, 95% CI 1.08 to 1.85), while having a medium mark on the loneliness scale raised odds 45% (1.45, 95% CI 1.14 to 1.84). Other factors independently associated with poor adherence in this analysis were younger age, harmful alcohol use, and nonmedicinal drug use. Being black rather than white cut odds of poor adherence about one third (aOR 0.62, 95% CI 0.47 to 0.84).
The researchers stressed that almost half of this study group had high scores on the combined loneliness scale, and that their analysis linked younger age to both a higher loneliness score and poor antiretroviral adherence. They see a need to study the potential impact of loneliness on HIV-related comorbidities.
References
1. Light L, Hui C, Hart T, Brennan D, Kroch AE. Loneliness and ARV adherence: results from a cohort study of people living with HIV in Ontario, Canada. AIDS 2022, July 29-August 2, Montreal. Abstract OAD0704.
2. The OHTN Cohort Study. https://ohtncohortstudy.ca/
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