Burch, Lisa Samantha; (2018) Impact of gender, sexual orientation and socio-economic factors on HIV treatment outcomes in the UK. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The effectiveness of antiretroviral therapy (ART) has led to greatly improved prognosis for people living with HIV, such that they now have a similar life expectancy to the general population. However, these improvements over time have not necessarily been seen equally among all demographic groups. The aim of this thesis was to investigate the differences in virological response to ART, treatment adherence, and late HIV diagnosis by gender and sexual orientation among people with HIV in the UK, and assess whether any differences have narrowed in more recent years. Additional analyses explored whether socio-economic factors could explain the observed differences in outcome across gender/sexual orientation groups. The analyses were based on data from two observational UK studies: the Royal Free HIV Cohort Study and the Antiretrovirals Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study. Results showed that, among individuals on ART, women and men who have sex with women (MSW) had a higher prevalence of detectable viral load and lower CD4 counts than men who have sex with men (MSM). Similarly, for initial response to first-line ART, virological outcomes were less favourable for women and MSW, compared to MSM even in the most recent years, and there was no evidence that these differences in outcome were narrowing over time. Socio-economic disadvantage (financial hardship; non-employment; renting; unstable housing status; non-university education) was strongly associated with higher prevalence of ART non-adherence and poorer virological outcomes. Socio-economic status explained much of the disparities in treatment outcomes between MSM and women, but less between MSW and MSM. A considerably higher prevalence of late diagnosis was seen among women and MSW compared to MSM. In conclusion, this thesis identified ongoing disparities in HIV outcomes between gender/sexual orientation groups. Clinical management strategies should focus on demographic and socio-economic groups at risk of poorer treatment outcomes.

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