Loneliness and ARV adherence: results from a cohort study of people living with HIV in Ontario, Canada

BACKGROUND: Social connectedness is important to human beings while loneliness can be detrimental to both mental and physical health. Our goal was to investigate the degree of loneliness experienced by people living with HIV (PLWH) and its impact on adherence to ARV medications using Ontario HIV Cohort Study (OCS).
METHODS: OCS, a study of people Living with HIV (PLWH), collects clinical and socio-behavioral data from 15 HIV clinics in Ontario, Canada. In 2020, a 3-item short UCLA Loneliness Scale was added to the annual questionnaire. A loneliness score was categorized into 3 levels (low:3-4, medium:5-6, high:7-9). Descriptive statistics and proportional odds models were used to identify factors correlated with loneliness. Impact of loneliness on ARV adherence was examined using logistic regression.
RESULTS: Mean age (STD) of the 1,870 participants who completed loneliness scale was 52.2 (12.1), 22.8% were females, 57.6% gay men, 60% white, 21.7 % black, and 2.5% Indigenous. 19.6% of participants often felt lacking companionship, 13.2% felt left out, and 17.9% felt isolated.Meanwhile, the majority hardly ever lacked companionship (49.6%), felt left out (60.7%) or isolated (53%). On the combined loneliness scale (range= 3-9, median (IQR) = 3(4-6)), 27.1% had medium level, and 20.7% had high level. Multivariable analysis reveals predictors of higher loneliness Score with OR(95%CI) are younger age 2.84(1.80,4.48) for <35, 3.18(2.22,4.55) for 35-49, 2.18(1,57,3.03) for 50-64 vs 65+ years old), being female 1.38(1.06,1.79), single 4.04(3.26,5.00), low income 1.51(1.23,1.85) for <$20,000/year, and using alcohol 1.49(1.08,2.07) and non-medicinal drugs 1.53(1.13,2.07). We found strong association between ARV non-adherence and higher loneliness scores [OR(95%CI)=1.45(1.14,1.84) for medium vs low, and 1.41(1.08,1.85) for high vs low)], adjusted for age, sex, race, alcohol, and drug use.
CONCLUSIONS: PLWH with higher loneliness scores are more likely to skip their ARV medications. About 13% to 20% of OCS participants experienced at least one of the three aspects of loneliness, almost half have high scores on the combined loneliness scale. More research is needed to identify relationship between loneliness and co-morbid conditions, such as substance use. Intervention strategies are need in communities of PLWH to combat loneliness, especially during current COVID-19 pandemic.