The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV

Figures & data

Table 1. Univariate descriptive and χ2 analysis of associations between patient characteristics and engagement with care.

	PRIME sample group	Adherence analysis		Optimal adherence	Suboptimal adherence	p value^a		Attendance analysis	Optimal attendance	Suboptimal attendance	p value^a
	N = 869 (%)	N = 661 (%)		N = 596 (91.2%)	N = 65 (9.8%)			N = 692 (%)	N = 549 (80.3%)	N = 143 (20.7%)
Median age in years, (range)	49 (47–52.5)	49 (47–52)		49 (47–52)	49 (45–51)	0.756		49 (45–51)	50 (45–52)	49 (46–52)	0.09
Ethnicity						0.094					0.12
Black African	607 (72.2)	472 (72.6)		430 (73.5)	42 (64.6)			487 (71.5)	381 (70.7)	106 (74.7)
White UK	71 (8.4)	59 (9.1)		48 (8.2)	11 (16.9)			62 (9.1)	53 (9.8)	9 (6.3)
Other	163 (19.4)	132 (18.3)		107 (18.3)	12 (18.5)			132 (19.4)	105 (19.5)	27 (19.0)
Employment						<0.001					0.35
Employed	552 (66.3)	442 (69.3)		409 (71.1)	33 (52.4)			465 (69.6)	377 (70.7)	88 (65.2)
Unemployed	281 (33.7)	196 (30.7)		166 (28.9)	30 (47.6)			203 (30.4)	156 (29.3)	47 (34.8)
Education						0.15					0.64
Did not complete school	93 (11.5)	68 (10.7)		62 (10.8)	6 (9.7)			70 (10.5)	52 (9.9)	18 (12.9)
“O” level^b	188 (23.2)	143 (22.6)		132 (23.1)	11 (17.7)			153 (23.0)	125 (23.9)	28 (20.0)
“A” level^c	170 (21.0)	125 (19.7)		106 (18.5)	19 (30.7)			135 (20.3)	107 (20.4)	28 (20.0)
University	360 (44.4)	298 (47.0)		272 (47.6)	26 (41.9)			306 (46.1)	240 (45.8)	66 (47.1)
Enough money for basic needs						0.013					0.14
All the time	312 (36.5)	262 (39.9)		248 (41.9)	14 (21.9)			277 (40.3)	226 (41.5)	51 (35.9)
Most of the time	225 (26.3)	167 (25.5)		143 (24.2)	24 (37.5)			170 (24.8)	140 (25.7)	30 (21.1)
Some/None of the time	319 (37.3)	227 (34.6)		201 (33.9)	26 (40.6)			240 (34.9)	179 (32.8)	61 (43.0)
Smoking						0.003					0.8
No	776 (91.7)	590 (91.3)		537 (92.4)	53 (81.5)			618 (91.4)	492 (91.2)	126 (92.0)
Yes	70 (8.3)	56 (8.7)		44 (7.6)	12 (18.5)			58 (8.6)	47 (8.7)	11 (8.0)
High risk alcohol use^d						<0.001					0.85
No	736 (91.4)	567 (91.0)		522 (92.7)	45 (75.0)			595 (91.0)	470 (91.1)	125 (90.6)
Yes	69 (8.6)	56 (9.0)		41 (7.3)	15 (25.0)			59 (9.0)	46 (8.9)	13 (9.4)
Recreational drug use						0.762					0.51
No	824 (97.5)	627 (97.4)		567 (97.4)	60 (96.8)			655 (97.2)	523 (97.4)	132 (96.3)
Yes	21 (2.5)	17 (2.6)		15 (2.6)	2 (3.2)			19 (2.8)	14 (2.6)	5 (3.7)
Median years since diagnosis (interquartile range)	14 (9–18)	14 (10–18)		14 (9–18)	16 (12.5–22)	0.005		14 (10–18)	14 (10–18)	13 (9–18)	0.89
Most recent CD4 count (cells/mm^3)						0.383					0.47
≥500	519 (68.2)	409 (69.3)		363 (68.6)	46 (75.4)			428 (69.5)	347 (70.5)	81 (65.3)
200–499	192 (25.2)	139 (23.6)		126 (23.8)	13 (21.3)			145 (23.5)	113 (23.0)	32 (25.8)
<200	50 (6.6)	42 (7.1)		40 (7.6)	2 (3.3)			43 (7.0)	32 (6.5)	11 (8.8)
Most recent HIV viral load						0.676
Undetectable	717 (88.0)	561 (89.0)		505 (89.2)	56 (87.5)			578 (87.8)	465 (89.1)	113 (83.9)	0.057
Detectable	98 (12.0)	69 (11.0)		61 (10.8)	8 (12.5)			80 (12.2)	57 (10.1)	23 (16.1)

	Adherence analysis		Optimal adherence	Suboptimal adherence	p value^a		Attendance analysis	Optimal attendance	Suboptimal attendance
	N = 661 (%)		N = 596 (91.2%)	N = 65 (9.8%)			N = 692 (%)	N = 549 (80.3%)	N = 143 (20.7%)	p value^a
Menopausal status					0.897					0.73
Pre-menopausal	146 (22.1)		132 (22.2)	14 (21.5)			151 (21.8)	119 (21.7)	32 (22.4)
Peri-menopausal	298 (45.1)		270 (45.3)	28 (43.1)			309 (44.7)	242 (44.1)	67 (46.9)
Post-menopausal	217 (32.8)		194 (32.6)	23 (35.4)			232 (33.5)	188 (34.2)	44 (30.8)
All menopausal symptoms					<0.001					0.14
None/mild/moderate	475 (71.9)		445 (74.7)	30 (46.2)			499 (72.1)	403 (73.4)	96 (67.1)
Severe	186 (28.1)		155 (25.3)	35 (53.9)			193 (27.9)	146 (26.6)	47 (32.9)
Somatic menopausal symptoms
None/mild/moderate	555 (84.0)		504 (84.6)	51 (78.5)	0.203		581 (84.0)	471 (81.1)	78 (70.3)	0.01
Severe	106 (16.0)		92 (15.4)	14 (21.5)			111 (16.0)	110 (18.9)	33 (29.7)
Psychological menopausal symptoms
None/mild/moderate	476 (72.0)		442 (74.2)	34 (52.3)	<0.001		501 (72.4)	409 (81.6)	140 (73.3)	0.02
Severe	185 (28.0)		154 (25.8)	31 (47.7)			191 (27.6)	92 (18.4)	51 (26.7)
Urogenital menopausal symptoms
None/mild/moderate	464 (70.2)		424 (71.1)	40 (61.5)	0.108		490 (70.8)	389 (79.4)	160 (79.2)	0.96
Severe	197 (29.8)		172 (28.9)	25 (38.5)			202 (29.2)	101 (20.6)	42 (20.8)

^a χ² or Kruskal-Wallis test;^b equivalent to completing US Grade 10; ^c equivalent to completing US Grade 12; ^d using the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool.

Table 2. Univariable and multivariable logistic regression analyses of the association between menopausal symptoms and suboptimal adherence to ART.

		Suboptimal adherence to ART
		OR	95% CI
All menopausal symptoms	None/mild/moderate (MRS <17)	Ref
	Severe (MRS ≥17)	3.44	2.04–5.79
Multivariable analysis (all symptoms)*	None/mild/moderate	Ref
	Severe	2.22	1.13–4.35
Somatic menopausal symptoms	None/mild/moderate	Ref
	Severe	1.50	0.80–2.83
Multivariable analysis (somatic)*	None/mild/moderate	Ref
	Severe	0.59	0.27–1.28
Psychological menopausal symptoms	None/mild/moderate	Ref
	Severe	2.62	1.56–4.40
Multivariable analysis (psychological)*	None/mild/moderate	Ref
	Severe	1.36	0.71–2.64
Urogenital menopausal symptoms	None/mild/moderate	Ref
	Severe	1.54	0.91–2.62
Multivariable analysis (urogenital)*	None/mild/moderate	Ref
	Severe	0.96	0.51–1.81
Number of severe symptoms	0/1	Ref
	2/3	2.01	1.16–3.49
Multivariable analysis (number of severe symptoms)*	0/1	Ref
	2/3	0.90	0.45–1.79
Menopausal status	Premenopausal	Ref
	Perimenopausal	0.98	0.50–1.92
	Postmenopausal	1.12	0.55–2.25

* adjusted for ethnicity, employment, high-risk alcohol use, current smoking, basic needs met and years since diagnosis

Table 3. Univariable and multivariable logistic regression analyses of the association between menopausal symptoms and suboptimal HIV clinic attendance.

		Suboptimal HIV clinic attendance
		OR	95% CI
All menopausal symptoms	None/mild/moderate (MRS <17)	Ref
	Severe (MRS ≥17)	1.35	0.91–2.01
Multivariable analysis (all symptoms)*	None/mild/moderate	Ref
	Severe	1.52	1.01–2.29
Somatic menopausal symptoms	None/mild/moderate	Ref
	Severe	1.81	1.15–2.86
Multivariable analysis (somatic)*	None/mild/moderate	Ref
	Severe	1.98	1.24–3.16
Psychological menopausal symptoms	None/mild/moderate	Ref
	Severe	1.62	1.09–2.40
Multivariable analysis (psychological)*	None/mild/moderate	Ref
	Severe	1.76	1.17–2.65
Urogenital menopausal symptoms	None/mild/moderate	Ref
	Severe	1.01	0.67–1.51
Multivariable analysis (urogenital)*	None/mild/moderate	Ref
	Severe	1.06	0.70–1.61
Number of severe symptoms	0/1	Ref
	2/3	1.48	0.96–2.26
Multivariable analysis (number of severe symptoms)*	0/1	Ref
	2/3	1.59	1.03–2.46
Menopausal status	Premenopausal	Ref
	Perimenopausal	1.03	0.64–1.66
	Postmenopausal	0.87	0.52–1.45

*adjusted for age and ethnicity