Prevalence, patterns, and associated factors of psychoactive substance use among people living with HIV in Lomé (Togo)

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Despite growing concern, there is limited data on the prevalence and correlates of substance use in this population in Togo. This study aimed to assess the prevalence, patterns, and associated factors of PAS use among PLHIV in Lomé. Methods A cross-sectional survey was conducted between August and October among PLHIV attending HIV clinic of the infectious and tropical diseases department of the CHU Sylvanus Olympio in Lomé. Data were collected using a structured, pre-tested questionnaire administered through face-to-face interviews. Information was gathered on sociodemographic characteristics, ART adherence, and use of PAS (alcohol, tobacco, cannabis, others). Multivariable logistic regression analysis was used to determine factors associated with substance use. Results A total of 510 PLHIV were included in this study, of which 71.6% were women. Their average age was 48.0 ± 9.5 years, and 38.4% had reported the consumption of any PAS. In the multivariable analysis, the age of PLHIV (40 and 49 years old: aOR = 0.57; p = 0.043; ref = “Less than 40 years old”); the female sex (aOR = 0.36; p < 0.001); level of education (primary level of education: aOR = 0.63; p = 0.041; ref = “secondary or higher level”); religion (Christian: aOR = 0.44; p = 0.020; Muslim: aOR = 0.17; p < 0.001; ref= “none or practicing a traditional religion”); adherence to ARV treatment (aOR = 0.49; p = 0.008) and being sexually active at the time (aOR = 1.69; p = 0.012) were the factors associated with the consumption of any PAS. Conclusion The high prevalence of psychoactive substance use among PLHIV in Lomé calls for urgent policy and programmatic action. Routine screening, counseling, and integrated interventions should be prioritized to address both substance use and HIV care outcomes. psychoactive substance PLHIV Togo Introduction Sub-Saharan Africa (SSA) remains disproportionately affected, accounting for approximately two-thirds of all global HIV infections [ 1 , 2 ]. Although the widespread availability of antiretroviral therapy (ART) has redefined HIV as a manageable chronic condition, the effectiveness of treatment is largely contingent upon sustained adherence and the adoption of health-promoting behaviors. One of the major impediments to optimal HIV care is the use of psychoactive substances (PAS), which has been consistently associated with suboptimal ART adherence, accelerated disease progression, and increased risk of HIV transmission [ 3 ]. PAS, including alcohol, tobacco, cannabis, opioids, and stimulants, can impair cognitive functioning, compromise adherence to treatment regimens, and contribute to engagement in high-risk sexual behaviors [ 4 ]. Studies conducted in SSA report widely varying prevalence rates of PAS use in this population, ranging from 3.8% to as high as 61% [ 5 – 8 ]. This broad range reflects differences in cultural norms, socioeconomic conditions, and methodological approaches across studies. Furthermore, PAS use frequently co-occurs with mental health disorders such as depression and anxiety, which further complicate HIV management and adversely affect clinical outcomes [ 6 ]. In Togo, the HIV prevalence among adults aged 15–49 years is estimated at 2.1%, with urban centers such as Lomé reporting higher rates due to population density, socioeconomic disparities, and structural vulnerabilities [ 7 ]. Despite this elevated burden, empirical data on the patterns and determinants of PAS use among PLHIV in Togo are limited, particularly in urban contexts such as Lomé. Regional studies in West Africa have highlighted the roles of sociocultural norms, economic hardship, and psychological distress in shaping substance use behaviors in this population [ 8 ]. However, specific evidence regarding the types of substances commonly used, frequency of use, and their implications for HIV treatment outcomes in Togo remains sparse. Understanding the intersection between substance use and HIV in Lomé is essential for several reasons: (1) Clinical implications: PAS use can undermine ART effectiveness, increase the likelihood of adverse drug reactions, and promote the development of drug-resistant HIV strains [ 9 ]. (2) Public health considerations: PAS use is linked to behaviors that heighten the risk of HIV transmission, such as inconsistent condom use and needle-sharing [ 10 – 12 ]. (3) Policy and programmatic considerations: In the absence of locally relevant data, national HIV programs may fail to implement evidence-based substance use screening protocols or harm reduction strategies. This study was designed to assess the prevalence, patterns, and correlates of psychoactive substance use among PLHIV receiving care in Lomé. The findings aim to support evidence-based policy formulation and inform the development of comprehensive, integrated HIV care services that address co-occurring substance use, thereby improving treatment adherence and reducing transmission risk in this population. Methods Study design This study employed a descriptive cross-sectional design and was carried out over a three-month period, from August to October 2023. The setting was the Department of Infectious and Tropical Diseases of the Centre Hospitalier Universitaire (CHU) Sylvanus Olympio in Lomé, Togo. CHU Sylvanus Olympio is the largest tertiary-level academic hospital in the country and serves as a national referral center for infectious diseases, including HIV/AIDS. The choice of this site was based on its large and diverse HIV-positive patient population, which provided a diverse profile of sample for assessing PAS use among PLHIV. Study population The study population consisted of PLHIV aged 18 years and older who were receiving outpatient care at the Department of Infectious and Tropical Diseases during the study period. Inclusion criteria were: (1) confirmed HIV diagnosis, (2) age ≥18 years, (3) currently under follow-up at CHU-SO, and (4) oral provision of informed consent to participate. Patients who were critically ill or unable to respond to the questionnaire were excluded. In our study, PLHIV aged 18 years and above, followed at the infectious and tropical diseases department of the CHU-SO and who have agreed to participate in our study were included. The minimum sample size was calculated using the formula for the estimation of a single population proportion (n = [(Zα/2) 2 *P(1-P)]/i 2 ) with the assumptions of 95% confidence level, marginal error (i) of 0.05, and 0.50 prevalence (P) of PAS use, given that is unknown in this population. Using these parameters, the initial calculated sample size was 384. After applying the finite population correction and accounting for a 20% non-response rate or incomplete data, the final target sample size was 462. However, to increase statistical power and compensate for any potential exclusions, a total of 510 participants were ultimately recruited. A convenience sampling method was used. Eligible participants were consecutively approached and invited to participate when they attended their scheduled clinical follow-up appointments. Each potential participant was screened for eligibility by a trained research assistant, who also explained the study objectives and procedures in detail before obtaining oral informed consent. Data collection In this study, data were collected using a pretested structured questionnaire via individual face-to-face interviews. The questionnaire included questions related to sociodemographic characteristics of the respondents, clinical, biological and therapeutic data, and behavioral data including sexual practices and substances use. Written informed consent was obtained from all the PLHIV, prior to participation. For confidentiality, no individual identifiers such as names or known code were used. Variables definition In this study, the primary outcome variable was self-reported PAS use within the past 12 months. This was assessed through direct participant interviews using a structured questionnaire. Participants were asked whether they had used any of the following substances during the previous year: alcohol, tobacco, or illicit drugs, including but not limited to cannabis, poppers, ecstasy, amphetamines, LSD, crack, cocaine, heroin, ketamine, subutex, GHB, and tramadol. Participants who reported the use of at least one of these substances were classified as “Yes” for PAS use, while those who reported none were classified as “No.” To explore potential correlates of PAS use, a range of socio-demographic and clinical explanatory variables were included: Socio-demographic characteristics Gender : Categorized as male or female, based on self-identification. Gender differences are important given known variations in substance use behaviors and social norms. Age : Participants were grouped into three age categories: <40 years, 40–49 years, and ≥50 years, to account for age-related differences in risk perception, exposure, and lifestyle behaviors. Level of education : Defined according to the highest level of formal education attained and categorized as no formal education, primary education, or secondary education or higher. Education level serves as a proxy for health literacy and socioeconomic status. Current relationship status : Dichotomized as living in a couple (married or cohabiting) or not living in a couple (single, divorced, or widowed), considering that social support may influence health behaviors, including substance use. Employment sector : Based on the participant’s main source of income, this variable was categorized into four groups: unemployed/no occupation, public sector, private sector, and informal sector. This classification provides insights into economic stability and its potential influence on substance use. Religious affiliation : Religion was grouped into three categories: no religion or traditional religion, Islam, and Christianity. Religious beliefs and community norms often play a role in shaping attitudes and behaviors related to substance use. Clinical characteristics Overweight/obesity: Determined using the participant’s body mass index (BMI) as recorded in medical records or reported by the participant. Participants were categorized as overweight/obese (BMI ≥25 kg/m²) or not overweight/obese (BMI <25 kg/m²). Adherence to antiretroviral (ART) treatment: Participants were classified as adherent if they reported taking ≥95% of prescribed ART doses in the past month, and as non-adherent if otherwise. Adherence was self-reported and corroborated where possible by medical records. CD4 cell count: The most recent CD4 count (cells/mm³) was retrieved from clinical records and categorized as <200, 200–499, or ≥500 cells/mm³ to reflect immune status and HIV disease progression. Viral load suppression: Defined as having a plasma HIV-1 RNA level <1000 copies/mL at the time of the study, based on laboratory records. Participants with a viral load ≥1000 copies/mL were classified as unsuppressed. Current sexual activity: Participants were asked whether they were sexually active (i.e., had engaged in sexual intercourse in the last three months). Responses were categorized as yes or no. This variable was included due to its potential link with PAS use for coping or sexual enhancement. Each of these variables was selected based on prior evidence suggesting a possible association with psychoactive substance use in people living with HIV and were incorporated into the statistical analysis to identify potential determinants of PAS use in the study population. Data entry and statistical analysis Data were collected and entered using EpiData version 3.1 to facilitate accurate and consistent data management. The dataset was then exported to STATA version 15.1 (StataCorp LLC, College Station, TX, USA) for all statistical analyses. Descriptive analysis: Descriptive statistics were employed to characterize the study population. Categorical variables were summarized as frequencies and percentages, providing an overview of participant distribution across groups. Continuous variables were first assessed for normality using the Shapiro-Wilk test. Normally distributed variables were described using means and standard deviations (SD), whereas non-normally distributed variables were summarized using medians and interquartile ranges (IQR). Comparative analysis: Comparisons between participants reporting PAS use and those who did not were conducted to identify differences in sociodemographic and clinical characteristics. For continuous variables following a normal distribution, group comparisons were performed using the Student’s t-test. For categorical variables, associations were evaluated using Pearson’s Chi-squared test; when expected cell counts were less than five, Fisher’s exact test was applied. Regression analysis: To investigate factors associated with PAS use, univariate logistic regression analyses were first conducted. Each potential predictor variable was independently tested to estimate crude odds ratios (OR) and their 95% confidence intervals (CI). Variables with a p-value < 0.25 in the univariate analysis were considered for inclusion in a multivariate logistic regression model to adjust for confounding and to identify independent predictors. The multivariate model was constructed using a stepwise approach, with variables retained based on statistical significance and clinical relevance. Adjusted odds ratios (aOR) with 95% CIs were reported for all variables in the final model. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test, and multicollinearity was evaluated by calculating variance inflation factors (VIFs). Throughout the analyses, a two-sided p-value < 0.05 was considered statistically significant. All statistical procedures were carried out using STATA version 15.1. Human Ethics and Consent to Participate declarations Verbal and written informed consent was obtained from all participants prior to their participation in the study. Participants were free to withdraw at any time if they wished. Data collection was anonymous and confidential, as was data analysis. The entire study was conducted in accordance with the recommendations of the Declaration of Helsinki for studies involving human subjects. Authorization from the Togolese Bioethics Committee for Health Research (CBRS) was also obtained before the start of our study. Results Characteristics of the study population A total of 510 PLHIV were included, of whom 365 (71.6%) were female. The mean age was 48.0 ± 9.5 years (range: 22–79 years), with individuals aged ≥ 50 years representing the largest proportion (42.0%). Overall, 41.6% were living with a partner, and 47.1% had attained at least secondary education. Most participants (67.4%) were employed in the informal sector, and 81.0% identified as Christian (Table I). Regarding clinical, biological, and therapeutic profiles, 32.5% were overweight or obese at the time of the survey. The mean duration since HIV diagnosis was 7.7 ± 4.3 years, and the mean duration of ART use was 7.3 years. The majority (86.3%) were receiving first-line ART. Good adherence was reported by 84.7% of participants, while 5.2% had documented virological failure. Psychoactive substance (PAS) use was reported by 196 participants (38.4%). Alcohol was the most frequently used PAS (n = 188; 36.9%), followed by tobacco smoking (n = 11; 2.2%), psychotropic medications (n = 5; 1.0%), and cannabis (n = 3; 0.6%) (Table I). Factors associated with psychoactive substance use Univariable logistic regression revealed that psychoactive substance (PAS) use was significantly associated with age (p = 0.029), gender (p < 0.001), educational level (p < 0.001), religious affiliation (p < 0.001), adherence to antiretroviral (ART) treatment (p = 0.006), and sexual activity (p < 0.001) (Table I). Multivariable logistic regression identified six factors independently associated with PAS use among PLHIV. Individuals aged 40–49 years were significantly less likely to use PAS compared to those under 40 (adjusted odds ratio [aOR] = 0.57; p = 0.043). Female participants had a lower likelihood of PAS use compared to males (aOR = 0.36; p < 0.001). Those with a secondary or higher education level were less likely to report PAS use than those with no formal education (aOR = 0.63; p = 0.041). Religious affiliation was also protective: Christians (aOR = 0.44; p = 0.020) and Muslims (aOR = 0.17; p < 0.001) were significantly less likely to use PAS compared to those practicing no religion or traditional beliefs. Furthermore, good adherence to ARV treatment was associated with a reduced likelihood of PAS use (aOR = 0.49; p = 0.008). In contrast, PLHIV who were sexually active at the time of the survey were more likely to report PAS use than those who were not (aOR = 1.69; p = 0.012) (Table II). Discussion This cross-sectional study is among the first to investigate the prevalence of psychoactive substance (PAS) use among people living with HIV (PLHIV) in a Togolese HIV clinic. Overall, approximately two-fifths (38.4%) of participants reported using at least one PAS, with alcohol being the most common. The prevalence of PAS use observed in our study was higher than that reported in Nigeria (21.7%) [ 13 ], but lower than rates documented in France (56.2%) [ 14 ] and Morocco (76.7%) [ 15 ]. Studies reporting higher prevalence often included a significant proportion of men who have sex with men (MSM), a population more likely to engage in chemsex or use illicit drugs in sexual contexts [ 15 , 16 ]. In contrast, our findings align with previous research in Togo [ 17 ] in which alcohol was the predominant PAS. This pattern likely reflects the fact that alcohol is legal and widely available in Togo, while illicit drugs are cost-prohibitive for most PLHIV. Given these findings, it is essential to raise awareness among PLHIV about the potential harmful interactions between PAS—particularly alcohol—and antiretroviral therapy (ART), as these interactions may reduce treatment efficacy [ 18 – 20 ]. Several factors were significantly associated with psychoactive substance (PAS) use in the study population, including age, sex, educational level, religious affiliation, antiretroviral therapy (ART) adherence, and sexual activity. Younger PLHIV were more likely to report PAS use than older participants. Female participants were significantly less likely to use PAS compared to males (aOR = 0.36; p < 0.001), consistent with findings from Nigeria by Olagunju et al. [ 13 ], where men reported higher prevalence. The lower rates among women in Togo may reflect strong sociocultural stigma, where female substance use is strongly stigmatized and often linked to prostitution or perceived moral deviance. Higher educational attainment was inversely associated with PAS use; participants with secondary or higher education were less likely to report PAS use compared with those without formal education. This finding aligns with Olagunju et al. [ 13 ], suggesting that greater health literacy may contribute to risk-averse behaviors. Religious affiliation appeared protective. Compared to participants without religious affiliation or those adhering to traditional beliefs, Christians and Muslims were less likely to report PAS use. This association may relate to religious doctrines prohibiting substance use and the social or moral stigma attached to such behaviors within faith communities. Poor ART adherence emerged as a strong correlate PAS use. Participants with suboptimal adherence were more likely to report PAS use, a finding consistent with previous research in Togo showing that alcohol impairs memory and compromises ART adherence [ 17 ]. Similar trends were reported by Jaquet et al. [ 21 ] in West Africa. These observations highlight substance use as a modifiable barrier to treatment success, underscoring the need for interventions such as psychosocial support and targeted substance use counseling. Sexual activity was also associated with PAS use; sexually active PLHIV at the time of the study were nearly twice as likely to report use compared to those who were not sexually active. This may reflect psychosocial stressors faced by sexually active PLHIV, including anxiety over transmission, fear of rejection, diminished self-perceived desirability, and social isolation, with PAS use serving as a coping mechanism. Limitations This study has several limitations. First, as a cross-sectional study conducted in a single HIV clinic, the findings may not be generalizable to the broader PLHIV population in Togo. Second, participants may have underreported their use of PAS, particularly illicit substances, due to social desirability bias or fear of stigma. This reluctance may have led to an underestimation of true prevalence. Additionally, some medical records lacked key information, including the exact dates of HIV diagnosis and ART initiation, partner serostatus, and specific types of PAS consumed. Although causality and temporality between PAS use and associated factors cannot be established due to the cross-sectional design, the study nonetheless provides valuable preliminary data on the prevalence and determinants of PAS use among PLHIV in Lomé. Implications for practice, policy, and research Clinical Practice Routine screening for PAS use should be integrated into HIV care services in Lomé. Healthcare providers should receive training in non-judgmental communication, adherence counseling, and the use of evidence-based approaches such as motivational interviewing to support PLHIV who use substances. Public health policy National HIV programs should incorporate harm reduction strategies, including community-based interventions that promote peer education, reduce stigma, and address the social determinants of PAS use. Health education Culturally tailored health promotion campaigns targeting high-risk populations, particularly young men and individuals with low educational attainment—are essential. Engagement of community and religious leaders can enhance outreach and reinforce behavior change. Future research Further longitudinal studies are needed to assess the impact of substance use on HIV treatment outcomes over time. Qualitative research should explore the psychosocial and contextual factors that drive substance use among PLHIV, including stigma, coping strategies, and community norms. Conclusion Psychoactive substance (PAS) use among people living with HIV (PLHIV) in Togo is highly prevalent and constitutes a complex public health challenge that intersects two critical areas: HIV management and substance use disorders. This dual burden complicates treatment adherence, increases the risk of HIV transmission, and adversely affects overall health outcomes. Effective responses demand increased awareness and training among healthcare providers to implement routine, nonjudgmental screening for substance use within HIV care settings. Moreover, establishing well-coordinated referral systems and integrated care models linking HIV treatment services with addiction support and mental health resources is essential to improve patient outcomes and reduce public health risks. Abbreviations AIDS : Acquired immunodeficiency syndrome ART : Antiretroviral Treatment CHU : Centre Hospitalier Universitaire HIV : Human Immunodeficiency Virus PLHIV : People Living Human Immunodeficiency Virus PAS : Psychoactive substance Declarations Ethics approval and consent to participate Verbal and written informed consent was obtained from all participants prior to their participation in the study. Participants were free to withdraw at any time if they wished. Data collection was anonymous and confidential, as was data analysis. The entire study was conducted in accordance with the recommendations of the Declaration of Helsinki for studies involving human subjects. Authorization from the Togolese Bioethics Committee for Health Research (CBRS) was also obtained before the start of our study. Consent of publication All authors have give their consent for the publication of the manuscript Availability of data materials Materials of the study are available on request Competing interests Authors declare no interest conflict Funding There was no funding for the study Authors contributions I. Y; B.S ; M.W. I; A.K.M. S : design of the study K. H; P. K; P.A.K and S.G. L wrote the main manuscript text and All authors reviewed the manuscript. Acknowledgments : Not applicable References Sanogo D. Aspects épidémiologiques du VIH/SIDA à Sikasso de 2000 à 2004. These Med.Bamako.2006 ; (162). Programme commun des Nations Unies sur le VIH/sida (ONUSIDA). Fiche d’information de l’ONUSIDA — Dernières statistiques sur l’état de l’épidémie de sida, statistiques mondiales sur le VIH [Internet]. 2019. Disponible sur : https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_fr.pdf [Internet]. [Cité 14 déc 2020]. Disponible sur : www.unaids.org/sites/default/files/media_asset. 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Tables Table I: characteristics of the study sample (N = 510) Patients characteristics (N = 510) n (%) Psychoactive substance use* p-value No, n (%) Yes, n (%) Age, years Less than 40 Between 40 and 49 50 and more 93 (18.2) 203 (39.8) 214 (42.0) 49 (52.7) 134 (66.0) 131 (61.2) 44 (47.3) 69 (34.0) 83 (38.8) 0.091 Gender Male Female 145 (28.4) 365 (71.6) 60 (41.4) 254 (69.6) 85 (58.6) 111 (30.4) <0.001 Profession Public sector employee Private sector employee Informal sector employee Housewife / no profession 7 (1.4) 21 (4.1) 344 (67.4) 138 (27.1) 2 (28.6) 7 (33.3) 213 (61.9) 92 (66.7) 5 (71.4) 14 (66.7) 131 (38.1) 46 (33.3) 0.008 Live in couple No Yes 298 (58.4) 212 (41.6) 194 (65.0) 120 (56.6) 104 (35.0) 92 (43.4) 0.055 Educational level No education Primary Secondary or higher 93 (18.2) 177 (34.7) 240 (47.1) 66 (71.0) 122 (68.9) 126 (52.5) 27 (29.0) 55 (31.1) 114 (47.5) 0.001 Religion No religion or traditional religion Islam Christianity 48 (9.4) 49 (9.6) 413 (81.0) 19 (39.6) 38 (77.5) 257 (62.2) 29 (60.4) 11 (22.5) 156 (37.8) 0.001 Overweight / obesity No Yes 344 (67.5) 166 (32.5) 207 (60.2) 107 (64.5) 137 (39.8) 59 (35.5) 0.351 Seropositivity duration, years 7.7 (±4.3) 7.8 (±4.2) 7.7 (±4.3) 0.892 Clinical stage I No Yes 16 (3.1) 494 (96.9) 10 (62.5) 304 (62.5) 6 (37.5) 190 (38.6) 0.938 Moderate or severe symptoms No Yes 488 (95.7) 22 (4.3) 298 (61.7) 16 (72.7) 190 (38.9) 6 (27.3) 0.276 First line of ART No Yes 70 (13.7) 440 (86.3) 46 (65.7) 268 (60.9) 24 (34.3) 172 (90.1) 0.443 ARV treatment duration, years 7.3 (±3.9) 7.4 (±4.0) 7.1 (±3.9) 0.433 Adherence to ARV treatment No Yes 78 (15.3) 432 (84.7) 37 (47.4) 277 (64.1) 41 (52.6) 155 (35.9) 0.005 CD4, cells/mm3 Less than 200 Between 200 and 500 More than 500 69 (13.7) 216 (42.9) 218 (43.4) 40 (58.0) 129 (59.7) 139 (63.8) 29 (42.0) 87 (40.3) 79 (36.2) 0.576 Virological failure (>1000copies/mm3) No Yes 477 (94.8) 26 (5.2) 293 (61.4) 15 (57.7) 184 (38.6) 11 (42.3) 0.704 Sexually active* No Yes 303 (59.4) 207 (40.6) 106 (51.2) 208 (68.6) 101 (48.8) 95 (31.4) <0.001 Psychoactive substance use No Yes 314 (61.6) 196 (38.4) Type of psychoactive substance Alcohol consumption Smoking Psychotrope use Cannabis use 188 (36.9) 11 (2.2) 5 (1.0) 3 (0.6) * during the last 3 months Table II: Logistic regression of factors associated with psychoactive substance use PLHIV followed-up at CHU-SO, Lomé Patients characteristics (N = 510) Univariable analysis Multivariable analysis OR [95% CI] p-value aOR [95% CI] p-value Age, years Less than 40 Between 40 and 49 50 and more 1 0.57 [0.35 ;0.95] 0.71 [0.43 ;1.15] 0.029 0.164 1 0.57 [0.33 ;0.98] 0.62 [0.35 ;1.08] 0.043 0.093 Sex Male Female 1 0.31 [0.21 ;0.46] < 0.001 1 0.36 [0.23 ;0.56] <0.001 Profession Public sector employee Private sector employee Informal sector employee Housewife / no profession 1 0.80 [0.12 ;5.21] 0.25 [0.05 ;1.29] 0.20 [0.04 ;1.07] 0.815 0.097 0.060 Live in couple No Yes 1 1.43 [1.00 ;2.05] 0.052 Educational level No education Primary Secondary or higher 1 1.10 [0.64 ;1.91] 2.21 [1.32 ;3.70] 0.729 0.002 1 0.70 [0.39 ;1.26] 0.63 [0.41 ;0.98] 0.238 0.041 Religion No religion or traditional religion Islam Christianity 1 0.19 [0.08 ;0.46] 0.40 [0.22 ;0.73] < 0.001 0.003 1 0.17 [0.64 ;0.44] 0.44 [0.22 ;0.88] <0.001 0.020 Overweight / obesity No Yes 1 0.83 [0.57 ;1.22] 0.352 Seropositivity duration, years 0.99 [0.96 ;1.04] 0.892 Clinical stage I No Yes 1 1.04 [0.37 ;2.91] 0.938 Moderate or severe symptoms No Yes 1 0.59 [0.23 ;1.53] 0.276 First line of ART No Yes 1 1.23 [0.72 ;2.09] 0.443 ARV treatment duration, years 0.98 [0.93 ;1.03] 0.433 Adherence to ARV treatment No Yes 1 0.50 [0.31 ;0.82] 0.006 1 0.49 [0.29 ;0.82] 0.008 CD4, cells/mm3 Less than 200 Between 200 and 500 More than 500 1 0.93 [0.54 ;1.61] 0.78 [0.45 ;1.36] 0.797 0.397 Virological failure (>1000copies/mm3) No Yes 1 1.17 [0.52 ;2.60] 0.704 Sexually active * No Yes 1 2.09 [1.45 ;3.01] < 0.001 1 1.69 [1.12 ;2.55] 0.012 * during the last 3 months Additional Declarations No competing interests reported. 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Although the widespread availability of antiretroviral therapy (ART) has redefined HIV as a manageable chronic condition, the effectiveness of treatment is largely contingent upon sustained adherence and the adoption of health-promoting behaviors. One of the major impediments to optimal HIV care is the use of psychoactive substances (PAS), which has been consistently associated with suboptimal ART adherence, accelerated disease progression, and increased risk of HIV transmission [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePAS, including alcohol, tobacco, cannabis, opioids, and stimulants, can impair cognitive functioning, compromise adherence to treatment regimens, and contribute to engagement in high-risk sexual behaviors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Studies conducted in SSA report widely varying prevalence rates of PAS use in this population, ranging from 3.8% to as high as 61% [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This broad range reflects differences in cultural norms, socioeconomic conditions, and methodological approaches across studies. Furthermore, PAS use frequently co-occurs with mental health disorders such as depression and anxiety, which further complicate HIV management and adversely affect clinical outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Togo, the HIV prevalence among adults aged 15\u0026ndash;49 years is estimated at 2.1%, with urban centers such as Lom\u0026eacute; reporting higher rates due to population density, socioeconomic disparities, and structural vulnerabilities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite this elevated burden, empirical data on the patterns and determinants of PAS use among PLHIV in Togo are limited, particularly in urban contexts such as Lom\u0026eacute;. Regional studies in West Africa have highlighted the roles of sociocultural norms, economic hardship, and psychological distress in shaping substance use behaviors in this population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, specific evidence regarding the types of substances commonly used, frequency of use, and their implications for HIV treatment outcomes in Togo remains sparse.\u003c/p\u003e\u003cp\u003eUnderstanding the intersection between substance use and HIV in Lom\u0026eacute; is essential for several reasons: (1) Clinical implications: PAS use can undermine ART effectiveness, increase the likelihood of adverse drug reactions, and promote the development of drug-resistant HIV strains [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. (2) Public health considerations: PAS use is linked to behaviors that heighten the risk of HIV transmission, such as inconsistent condom use and needle-sharing [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. (3) Policy and programmatic considerations: In the absence of locally relevant data, national HIV programs may fail to implement evidence-based substance use screening protocols or harm reduction strategies.\u003c/p\u003e\u003cp\u003eThis study was designed to assess the prevalence, patterns, and correlates of psychoactive substance use among PLHIV receiving care in Lom\u0026eacute;. The findings aim to support evidence-based policy formulation and inform the development of comprehensive, integrated HIV care services that address co-occurring substance use, thereby improving treatment adherence and reducing transmission risk in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a descriptive cross-sectional design and was carried out over a three-month period, from August to October 2023. The setting was the Department of Infectious and Tropical Diseases of the Centre Hospitalier Universitaire (CHU) Sylvanus Olympio in Lom\u0026eacute;, Togo. CHU Sylvanus Olympio is the largest tertiary-level academic hospital in the country and serves as a national referral center for infectious diseases, including HIV/AIDS. The choice of this site was based on its large and diverse HIV-positive patient population, which provided a diverse profile of sample for assessing PAS use among PLHIV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of PLHIV aged 18 years and older who were receiving outpatient care at the Department of Infectious and Tropical Diseases during the study period. Inclusion criteria were: (1) confirmed HIV diagnosis, (2) age \u0026ge;18 years, (3) currently under follow-up at CHU-SO, and (4) oral provision of informed consent to participate. Patients who were critically ill or unable to respond to the questionnaire were excluded.\u003c/p\u003e\n\u003cp\u003eIn our study, PLHIV aged 18 years and above, followed at the infectious and tropical diseases department of the CHU-SO and who have agreed to participate in our study were included.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe minimum sample size was calculated using the formula for the estimation of a single population proportion (n = [(Z\u0026alpha;/2)\u003csup\u003e2\u003c/sup\u003e*P(1-P)]/i\u003csup\u003e2\u003c/sup\u003e) with the assumptions of 95% confidence level, marginal error (i) of 0.05, and 0.50 prevalence (P) of PAS use, given that is unknown in this population. Using these parameters, the initial calculated sample size was 384. After applying the finite population correction and accounting for a 20% non-response rate or incomplete data, the final target sample size was 462. However, to increase statistical power and compensate for any potential exclusions, a total of 510 participants were ultimately recruited.\u003c/p\u003e\n\u003cp\u003eA convenience sampling method was used. Eligible participants were consecutively approached and invited to participate when they attended their scheduled clinical follow-up appointments. Each potential participant was screened for eligibility by a trained research assistant, who also explained the study objectives and procedures in detail before obtaining oral informed consent.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, data were collected using a pretested structured questionnaire via individual face-to-face interviews. The questionnaire included questions related to sociodemographic characteristics of the respondents, clinical, biological and therapeutic data, and behavioral data including sexual practices and substances use. Written informed consent was obtained from all the PLHIV, prior to participation. For confidentiality, no individual identifiers such as names or known code were used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables definition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the primary outcome variable was self-reported PAS use within the past 12 months. This was assessed through direct participant interviews using a structured questionnaire. Participants were asked whether they had used any of the following substances during the previous year: alcohol, tobacco, or illicit drugs, including but not limited to cannabis, poppers, ecstasy, amphetamines, LSD, crack, cocaine, heroin, ketamine, subutex, GHB, and tramadol. Participants who reported the use of at least one of these substances were classified as \u0026ldquo;Yes\u0026rdquo; for PAS use, while those who reported none were classified as \u0026ldquo;No.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eTo explore potential correlates of PAS use, a range of socio-demographic and clinical explanatory variables were included:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocio-demographic characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eGender\u003c/em\u003e: Categorized as male or female, based on self-identification. Gender differences are important given known variations in substance use behaviors and social norms.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eAge\u003c/em\u003e: Participants were grouped into three age categories: \u0026lt;40 years, 40\u0026ndash;49 years, and \u0026ge;50 years, to account for age-related differences in risk perception, exposure, and lifestyle behaviors.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eLevel of education\u003c/em\u003e: Defined according to the highest level of formal education attained and categorized as no formal education, primary education, or secondary education or higher. Education level serves as a proxy for health literacy and socioeconomic status.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eCurrent relationship status\u003c/em\u003e: Dichotomized as living in a couple (married or cohabiting) or not living in a couple (single, divorced, or widowed), considering that social support may influence health behaviors, including substance use.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eEmployment sector\u003c/em\u003e: Based on the participant\u0026rsquo;s main source of income, this variable was categorized into four groups: unemployed/no occupation, public sector, private sector, and informal sector. This classification provides insights into economic stability and its potential influence on substance use.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eReligious affiliation\u003c/em\u003e: Religion was grouped into three categories: no religion or traditional religion, Islam, and Christianity. Religious beliefs and community norms often play a role in shaping attitudes and behaviors related to substance use.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eOverweight/obesity: Determined using the participant\u0026rsquo;s body mass index (BMI) as recorded in medical records or reported by the participant. Participants were categorized as overweight/obese (BMI \u0026ge;25 kg/m\u0026sup2;) or not overweight/obese (BMI \u0026lt;25 kg/m\u0026sup2;).\u003c/li\u003e\n \u003cli\u003eAdherence to antiretroviral (ART) treatment: Participants were classified as adherent if they reported taking \u0026ge;95% of prescribed ART doses in the past month, and as non-adherent if otherwise. Adherence was self-reported and corroborated where possible by medical records.\u003c/li\u003e\n \u003cli\u003eCD4 cell count: The most recent CD4 count (cells/mm\u0026sup3;) was retrieved from clinical records and categorized as \u0026lt;200, 200\u0026ndash;499, or \u0026ge;500 cells/mm\u0026sup3; to reflect immune status and HIV disease progression.\u003c/li\u003e\n \u003cli\u003eViral load suppression: Defined as having a plasma HIV-1 RNA level \u0026lt;1000 copies/mL at the time of the study, based on laboratory records. Participants with a viral load \u0026ge;1000 copies/mL were classified as unsuppressed.\u003c/li\u003e\n \u003cli\u003eCurrent sexual activity: Participants were asked whether they were sexually active (i.e., had engaged in sexual intercourse in the last three months). Responses were categorized as yes or no. This variable was included due to its potential link with PAS use for coping or sexual enhancement.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEach of these variables was selected based on prior evidence suggesting a possible association with psychoactive substance use in people living with HIV and were incorporated into the statistical analysis to identify potential determinants of PAS use in the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData entry and statistical analysis\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were collected and entered using EpiData version 3.1 to facilitate accurate and consistent data management. The dataset was then exported to STATA version 15.1 (StataCorp LLC, College Station, TX, USA) for all statistical analyses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDescriptive analysis:\u0026nbsp;\u003c/em\u003eDescriptive statistics were employed to characterize the study population. Categorical variables were summarized as frequencies and percentages, providing an overview of participant distribution across groups. Continuous variables were first assessed for normality using the Shapiro-Wilk test. Normally distributed variables were described using means and standard deviations (SD), whereas non-normally distributed variables were summarized using medians and interquartile ranges (IQR).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eComparative analysis:\u0026nbsp;\u003c/em\u003eComparisons between participants reporting PAS use and those who did not were conducted to identify differences in sociodemographic and clinical characteristics. For continuous variables following a normal distribution, group comparisons were performed using the Student\u0026rsquo;s t-test. For categorical variables, associations were evaluated using Pearson\u0026rsquo;s Chi-squared test; when expected cell counts were less than five, Fisher\u0026rsquo;s exact test was applied.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRegression analysis:\u0026nbsp;\u003c/em\u003eTo investigate factors associated with PAS use, univariate logistic regression analyses were first conducted. Each potential predictor variable was independently tested to estimate crude odds ratios (OR) and their 95% confidence intervals (CI). Variables with a p-value \u0026lt; 0.25 in the univariate analysis were considered for inclusion in a multivariate logistic regression model to adjust for confounding and to identify independent predictors.\u003c/p\u003e\n\u003cp\u003eThe multivariate model was constructed using a stepwise approach, with variables retained based on statistical significance and clinical relevance. Adjusted odds ratios (aOR) with 95% CIs were reported for all variables in the final model. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test, and multicollinearity was evaluated by calculating variance inflation factors (VIFs).\u003c/p\u003e\n\u003cp\u003eThroughout the analyses, a two-sided p-value \u0026lt; 0.05 was considered statistically significant. All statistical procedures were carried out using STATA version 15.1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal and written informed consent was obtained from all participants prior to their participation in the study. Participants were free to withdraw at any time if they wished.\u003c/p\u003e\n\u003cp\u003eData collection was anonymous and confidential, as was data analysis. The entire study was conducted in accordance with the recommendations of the Declaration of Helsinki for studies involving human subjects.\u003c/p\u003e\n\u003cp\u003eAuthorization from the Togolese Bioethics Committee for Health Research (CBRS) was also obtained before the start of our study.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of the study population\u003c/h2\u003e\u003cp\u003eA total of 510 PLHIV were included, of whom 365 (71.6%) were female. The mean age was 48.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 years (range: 22\u0026ndash;79 years), with individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years representing the largest proportion (42.0%). Overall, 41.6% were living with a partner, and 47.1% had attained at least secondary education. Most participants (67.4%) were employed in the informal sector, and 81.0% identified as Christian (Table I).\u003c/p\u003e\u003cp\u003eRegarding clinical, biological, and therapeutic profiles, 32.5% were overweight or obese at the time of the survey. The mean duration since HIV diagnosis was 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years, and the mean duration of ART use was 7.3 years. The majority (86.3%) were receiving first-line ART. Good adherence was reported by 84.7% of participants, while 5.2% had documented virological failure.\u003c/p\u003e\u003cp\u003ePsychoactive substance (PAS) use was reported by 196 participants (38.4%). Alcohol was the most frequently used PAS (n\u0026thinsp;=\u0026thinsp;188; 36.9%), followed by tobacco smoking (n\u0026thinsp;=\u0026thinsp;11; 2.2%), psychotropic medications (n\u0026thinsp;=\u0026thinsp;5; 1.0%), and cannabis (n\u0026thinsp;=\u0026thinsp;3; 0.6%) (Table I).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with psychoactive substance use\u003c/h2\u003e\u003cp\u003eUnivariable logistic regression revealed that psychoactive substance (PAS) use was significantly associated with age (p\u0026thinsp;=\u0026thinsp;0.029), gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), educational level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), religious affiliation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), adherence to antiretroviral (ART) treatment (p\u0026thinsp;=\u0026thinsp;0.006), and sexual activity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table I).\u003c/p\u003e\u003cp\u003eMultivariable logistic regression identified six factors independently associated with PAS use among PLHIV. Individuals aged 40\u0026ndash;49 years were significantly less likely to use PAS compared to those under 40 (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;0.57; p\u0026thinsp;=\u0026thinsp;0.043). Female participants had a lower likelihood of PAS use compared to males (aOR\u0026thinsp;=\u0026thinsp;0.36; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Those with a secondary or higher education level were less likely to report PAS use than those with no formal education (aOR\u0026thinsp;=\u0026thinsp;0.63; p\u0026thinsp;=\u0026thinsp;0.041). Religious affiliation was also protective: Christians (aOR\u0026thinsp;=\u0026thinsp;0.44; p\u0026thinsp;=\u0026thinsp;0.020) and Muslims (aOR\u0026thinsp;=\u0026thinsp;0.17; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly less likely to use PAS compared to those practicing no religion or traditional beliefs. Furthermore, good adherence to ARV treatment was associated with a reduced likelihood of PAS use (aOR\u0026thinsp;=\u0026thinsp;0.49; p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e\u003cp\u003eIn contrast, PLHIV who were sexually active at the time of the survey were more likely to report PAS use than those who were not (aOR\u0026thinsp;=\u0026thinsp;1.69; p\u0026thinsp;=\u0026thinsp;0.012) (Table II).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study is among the first to investigate the prevalence of psychoactive substance (PAS) use among people living with HIV (PLHIV) in a Togolese HIV clinic. Overall, approximately two-fifths (38.4%) of participants reported using at least one PAS, with alcohol being the most common.\u003c/p\u003e\u003cp\u003eThe prevalence of PAS use observed in our study was higher than that reported in Nigeria (21.7%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], but lower than rates documented in France (56.2%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Morocco (76.7%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Studies reporting higher prevalence often included a significant proportion of men who have sex with men (MSM), a population more likely to engage in chemsex or use illicit drugs in sexual contexts [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In contrast, our findings align with previous research in Togo [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in which alcohol was the predominant PAS. This pattern likely reflects the fact that alcohol is legal and widely available in Togo, while illicit drugs are cost-prohibitive for most PLHIV.\u003c/p\u003e\u003cp\u003eGiven these findings, it is essential to raise awareness among PLHIV about the potential harmful interactions between PAS\u0026mdash;particularly alcohol\u0026mdash;and antiretroviral therapy (ART), as these interactions may reduce treatment efficacy [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral factors were significantly associated with psychoactive substance (PAS) use in the study population, including age, sex, educational level, religious affiliation, antiretroviral therapy (ART) adherence, and sexual activity. Younger PLHIV were more likely to report PAS use than older participants.\u003c/p\u003e\u003cp\u003eFemale participants were significantly less likely to use PAS compared to males (aOR\u0026thinsp;=\u0026thinsp;0.36; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consistent with findings from Nigeria by Olagunju et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], where men reported higher prevalence. The lower rates among women in Togo may reflect strong sociocultural stigma, where female substance use is strongly stigmatized and often linked to prostitution or perceived moral deviance.\u003c/p\u003e\u003cp\u003eHigher educational attainment was inversely associated with PAS use; participants with secondary or higher education were less likely to report PAS use compared with those without formal education. This finding aligns with Olagunju et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], suggesting that greater health literacy may contribute to risk-averse behaviors.\u003c/p\u003e\u003cp\u003eReligious affiliation appeared protective. Compared to participants without religious affiliation or those adhering to traditional beliefs, Christians and Muslims were less likely to report PAS use. This association may relate to religious doctrines prohibiting substance use and the social or moral stigma attached to such behaviors within faith communities.\u003c/p\u003e\u003cp\u003ePoor ART adherence emerged as a strong correlate PAS use. Participants with suboptimal adherence were more likely to report PAS use, a finding consistent with previous research in Togo showing that alcohol impairs memory and compromises ART adherence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Similar trends were reported by Jaquet et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] in West Africa. These observations highlight substance use as a modifiable barrier to treatment success, underscoring the need for interventions such as psychosocial support and targeted substance use counseling.\u003c/p\u003e\u003cp\u003eSexual activity was also associated with PAS use; sexually active PLHIV at the time of the study were nearly twice as likely to report use compared to those who were not sexually active. This may reflect psychosocial stressors faced by sexually active PLHIV, including anxiety over transmission, fear of rejection, diminished self-perceived desirability, and social isolation, with PAS use serving as a coping mechanism.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has several limitations. First, as a cross-sectional study conducted in a single HIV clinic, the findings may not be generalizable to the broader PLHIV population in Togo. Second, participants may have underreported their use of PAS, particularly illicit substances, due to social desirability bias or fear of stigma. This reluctance may have led to an underestimation of true prevalence. Additionally, some medical records lacked key information, including the exact dates of HIV diagnosis and ART initiation, partner serostatus, and specific types of PAS consumed.\u003c/p\u003e\u003cp\u003eAlthough causality and temporality between PAS use and associated factors cannot be established due to the cross-sectional design, the study nonetheless provides valuable preliminary data on the prevalence and determinants of PAS use among PLHIV in Lom\u0026eacute;.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eImplications for practice, policy, and research\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eClinical Practice\u003c/strong\u003e\u003cp\u003eRoutine screening for PAS use should be integrated into HIV care services in Lom\u0026eacute;. Healthcare providers should receive training in non-judgmental communication, adherence counseling, and the use of evidence-based approaches such as motivational interviewing to support PLHIV who use substances.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePublic health policy\u003c/strong\u003e\u003cp\u003eNational HIV programs should incorporate harm reduction strategies, including community-based interventions that promote peer education, reduce stigma, and address the social determinants of PAS use.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHealth education\u003c/strong\u003e\u003cp\u003eCulturally tailored health promotion campaigns targeting high-risk populations, particularly young men and individuals with low educational attainment\u0026mdash;are essential. Engagement of community and religious leaders can enhance outreach and reinforce behavior change.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFuture research\u003c/strong\u003e\u003cp\u003eFurther longitudinal studies are needed to assess the impact of substance use on HIV treatment outcomes over time. Qualitative research should explore the psychosocial and contextual factors that drive substance use among PLHIV, including stigma, coping strategies, and community norms.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePsychoactive substance (PAS) use among people living with HIV (PLHIV) in Togo is highly prevalent and constitutes a complex public health challenge that intersects two critical areas: HIV management and substance use disorders. This dual burden complicates treatment adherence, increases the risk of HIV transmission, and adversely affects overall health outcomes. Effective responses demand increased awareness and training among healthcare providers to implement routine, nonjudgmental screening for substance use within HIV care settings. Moreover, establishing well-coordinated referral systems and integrated care models linking HIV treatment services with addiction support and mental health resources is essential to improve patient outcomes and reduce public health risks.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS : Acquired immunodeficiency syndrome\u003c/p\u003e\n\u003cp\u003eART : Antiretroviral Treatment\u003c/p\u003e\n\u003cp\u003eCHU : Centre Hospitalier Universitaire\u003c/p\u003e\n\u003cp\u003eHIV : Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003ePLHIV : People Living Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003ePAS : Psychoactive substance\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal and written informed consent was obtained from all participants prior to their participation in the study. Participants were free to withdraw at any time if they wished.\u003c/p\u003e\n\u003cp\u003eData collection was anonymous and confidential, as was data analysis. The entire study was conducted in accordance with the recommendations of the Declaration of Helsinki for studies involving human subjects.\u003c/p\u003e\n\u003cp\u003eAuthorization from the Togolese Bioethics Committee for Health Research (CBRS) was also obtained before the start of our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have give their consent for the publication of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaterials of the study are available on request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no interest conflict\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI. Y; B.S ; M.W. I; \u0026nbsp;A.K.M. S : design of the study\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;K. H; P. K; \u0026nbsp;P.A.K and S.G. L wrote the main manuscript text and\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments : Not applicable\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSanogo D. Aspects \u0026eacute;pid\u0026eacute;miologiques du VIH/SIDA \u0026agrave; Sikasso de 2000 \u0026agrave; 2004. These Med.Bamako.2006 ; (162). \u003c/li\u003e\n\u003cli\u003eProgramme commun des Nations Unies sur le VIH/sida (ONUSIDA). Fiche d\u0026rsquo;information de l\u0026rsquo;ONUSIDA \u0026mdash; Derni\u0026egrave;res statistiques sur l\u0026rsquo;\u0026eacute;tat de l\u0026rsquo;\u0026eacute;pid\u0026eacute;mie de sida, statistiques mondiales sur le VIH [Internet]. 2019. 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Consommation de substances psychoactives chez les jeunes en France et dans certains pays \u0026agrave; revenus \u0026eacute;lev\u0026eacute;s. \u0026Eacute;tat des lieux des modes et niveaux de consommation et facteurs associ\u0026eacute;s [Internet]. Saint-Maurice : Sante publique France ; 2019. 45 p. Disponible sur : www.santepubliquefrance.fr.\u003c/li\u003e\n\u003cli\u003eBirungi C, Ssembajjwe W, Salisbury TT, Levin J, Nakasujja N, Mpango RS. Substance use among HIV-infected adolescents in Uganda: rates and association with potential risks and outcome factors. AIDS Care. 2020;33(2):137‑47.\u003c/li\u003e\n\u003cli\u003eMuyindike W. R. et al. Phosphatidylethanol confirmed alcohol use among ART-na\u0026iuml;ve HIV-infected persons who denied consumption in rural Uganda. AIDS Care. 2017 ;29(11) :1442‑7.\u003c/li\u003e\n\u003cli\u003eKader R., Seedat S., Koch J. R., et Parry C. D. \u0026laquo; A preliminary investigation of the AUDIT and DUDIT in comparison to biomarkers for alcohol and drug use among HIV-infected clinic attendees in Cape Town, South Africa \u0026raquo;, \u003cem\u003eAfr. J. Psychiatry\u003c/em\u003e. 2012 ;15(5) :346‑51. \u003c/li\u003e\n\u003cli\u003eHahn JA, Cheng DM, Emenyonu NI, Lloyd-Travaglini C, Fatch R, Shade SB. Alcohol use and HIV disease progression in an antiretroviral naive cohort. J Acquir Immune Defic Syndr 1999. 2018 ;77(5) :492‑501. \u003c/li\u003e\n\u003cli\u003eProgramme National de Lutte contre le Sida et les IST (PNLS-IST). RAPPORT ANNUEL 2019 DES ACTIVITES DU PNLS-IST. Lom\u0026eacute; : PNLS-IST ; 2021 p. 65. \u003c/li\u003e\n\u003cli\u003eAkindipe T, Abiodun L, Adebajo S, Lawal R, Rataemane S. From addiction to infection: managing drug abuse in the context of HIV/AIDS in Africa. Afr J Reprod Health. 2014;18(3):47‑54. \u003c/li\u003e\n\u003cli\u003eANCE-TOGO. Collecte de donn\u0026eacute;es sur les drogues [Internet]. 2018 [cit\u0026eacute; 22 nov 2020]. Disponible sur : https://www.ancetogo.org/sante-publique-3/lutte-contre-les-drogues/collecte-de-donnees-sur-les-drogues.htlm. \u003c/li\u003e\n\u003cli\u003eOlagunju AT, Ogundipe OA, Olagunju TO, Campbell OA, Aina OF, Akanmu AS. psychoactive substance use among nigerian cohort with hiv/aids: frequency, types and demographic correlates. Ethiop Med J. 2017 ;55(1) :37‑41. \u003c/li\u003e\n\u003cli\u003eJacquet J-M, Peyriere H, Makinson A, Peries M, Nagot N, Donnadieu-Rigole H. Psychoactive substances, alcohol and tobacco consumption in HIV-infected outpatients. AIDS. 2018;32(9):1165‑71.\u003c/li\u003e\n\u003cli\u003eZaimi O. L\u0026rsquo;usage de substances psychoactives chez les patients vivant avec le VIH. (Enqu\u0026ecirc;te aupr\u0026egrave;s de 103 patients). PhD Thesis.Maroc.2013.202p. \u003c/li\u003e\n\u003cli\u003eLoua A, Dramou CD, Haba NY, Magassouba FB, Lamah M, Camara A. Profil h\u0026eacute;matologique des patients infect\u0026eacute;s par le VIH \u0026agrave; Conakry. Hematologie. 2011 ;17(5) :365‑9. \u003c/li\u003e\n\u003cli\u003eYaya I, Landoh DE, Saka B, Wasswa P, Aboubakari A, N\u0026rsquo;Dri MK. Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokod\u0026eacute;, Togo. BMC Public Health. 2014;14(1): 1308.doi: \u003c/li\u003e\n\u003cli\u003eAkindipe T, Abiodun L, Adebajo S, Lawal R, Rataemane S. From addiction to infection: managing drug abuse in the context of HIV/AIDS in Africa. Afr J Reprod Health. 2014;18(3):47 54. \u003c/li\u003e\n\u003cli\u003eGrelotti DJ, Closson EF, Smit JA, Mabude Z, Matthews LT, Safren SA. Whoonga: potential recreational use of HIV antiretroviral medication in South Africa. AIDS Behav. 2014;18(3):511 8. \u003c/li\u003e\n\u003cli\u003eGatch MB, Kozlenkov A, Huang R-Q, Yang W, Nguyen JD, Gonz\u0026aacute;lez-Maeso J. The HIV antiretroviral drug efavirenz has LSD-like properties. Neuropsychopharmacology. 2013 ;38(12) :2373 84.\u003c/li\u003e\n\u003cli\u003eJaquet A, Ekouevi DK, Bashi J, Aboubakrine M, Messou E, Maiga M. Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa. Addiction. 2010 ;105(8) :1416‑21. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I: characteristics of the study sample (N = 510)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients characteristics\u0026nbsp;(N = 510)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychoactive substance use*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLess than 40\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBetween 40 and 49\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e50 and more\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e93 (18.2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e203 (39.8)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e214 (42.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e49 (52.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e134 (66.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e131 (61.2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e44 (47.3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e69 (34.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e83 (38.8)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFemale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e145 (28.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e365 (71.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e60 (41.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e254 (69.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e85 (58.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e111 (30.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePublic sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrivate sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eInformal sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eHousewife / no profession\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e7 (1.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e21 (4.1)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e344 (67.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e138 (27.1)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e2 (28.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e7 (33.3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e213 (61.9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e92 (66.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e5 (71.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e14 (66.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e131 (38.1)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e46 (33.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLive in couple\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e298 (58.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e212 (41.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e194 (65.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e120 (56.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e104 (35.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e92 (43.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo education\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrimary\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSecondary or higher\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e93 (18.2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e177 (34.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e240 (47.1)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e66 (71.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e122 (68.9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e126 (52.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e27 (29.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e55 (31.1)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e114 (47.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo religion or traditional religion\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIslam\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eChristianity\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e48 (9.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e49 (9.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e413 (81.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e19 (39.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e38 (77.5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e257 (62.2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e29 (60.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e11 (22.5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e156 (37.8)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight / obesity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e344 (67.5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e166 (32.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e207 (60.2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e107 (64.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e137 (39.8)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e59 (35.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeropositivity duration,\u0026nbsp;\u003c/strong\u003e\u003cem\u003eyears\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.7 (\u0026plusmn;4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.8 (\u0026plusmn;4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7 (\u0026plusmn;4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical stage I\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e16 (3.1)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e494 (96.9)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e10 (62.5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e304 (62.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e6 (37.5)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e190 (38.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate or severe symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e488 (95.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e22 (4.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e298 (61.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e16 (72.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e190 (38.9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e6 (27.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst line of ART\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e70 (13.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e440 (86.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e46 (65.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e268 (60.9)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e24 (34.3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e172 (90.1)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARV treatment duration,\u0026nbsp;\u003c/strong\u003e\u003cem\u003eyears\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.3 (\u0026plusmn;3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.4 (\u0026plusmn;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.1 (\u0026plusmn;3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.433\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence to ARV treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e78 (15.3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e432 (84.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e37 (47.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e277 (64.1)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e41 (52.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e155 (35.9)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCD4, cells/mm3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLess than 200\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBetween 200 and 500\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMore than 500\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e69 (13.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e216 (42.9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e218 (43.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e40 (58.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e129 (59.7)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e139 (63.8)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e29 (42.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e87 (40.3)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e79 (36.2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVirological failure (\u0026gt;1000copies/mm3)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e477 (94.8)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e26 (5.2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e293 (61.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e15 (57.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e184 (38.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e11 (42.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexually active*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e303 (59.4)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e207 (40.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e106 (51.2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e208 (68.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e101 (48.8)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95 (31.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychoactive substance use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e314 (61.6)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e196 (38.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of psychoactive substance\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAlcohol consumption\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSmoking\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePsychotrope use\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eCannabis use\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e188 (36.9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e11 (2.2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e5 (1.0)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e3 (0.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u0026nbsp;\u003c/strong\u003e\u003cem\u003eduring the last 3 months\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable II: Logistic regression of factors associated with psychoactive substance use PLHIV followed-up at CHU-SO, Lom\u0026eacute;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients characteristics\u0026nbsp;(N = 510)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariable analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariable analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR [95% CI]\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR [95% CI]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLess than 40\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBetween 40 and 49\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e50 and more\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.57 [0.35\u0026nbsp;;0.95]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.71 [0.43\u0026nbsp;;1.15]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.164\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.57 [0.33\u0026nbsp;;0.98]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.62 [0.35\u0026nbsp;;1.08]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.043\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFemale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.31 [0.21\u0026nbsp;;0.46]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.36 [0.23\u0026nbsp;;0.56]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePublic sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrivate sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eInformal sector employee\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eHousewife / no profession\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.80 [0.12\u0026nbsp;;5.21]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.25 [0.05\u0026nbsp;;1.29]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.20 [0.04\u0026nbsp;;1.07]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLive in couple\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.43 [1.00\u0026nbsp;;2.05]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.052\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo education\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrimary\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSecondary or higher\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.10 [0.64\u0026nbsp;;1.91]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e2.21 [1.32\u0026nbsp;;3.70]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.70 [0.39\u0026nbsp;;1.26]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.63 [0.41\u0026nbsp;;0.98]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo religion or traditional religion\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIslam\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eChristianity\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.19 [0.08\u0026nbsp;;0.46]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.40 [0.22\u0026nbsp;;0.73]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.17 [0.64\u0026nbsp;;0.44]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.44 [0.22\u0026nbsp;;0.88]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverweight / obesity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.83 [0.57\u0026nbsp;;1.22]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeropositivity duration, years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.99 [0.96\u0026nbsp;;1.04]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical stage I\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.04 [0.37\u0026nbsp;;2.91]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.938\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate or severe symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.59 [0.23\u0026nbsp;;1.53]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.276\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst line of ART\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.23 [0.72\u0026nbsp;;2.09]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.443\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARV treatment duration,\u0026nbsp;\u003c/strong\u003e\u003cem\u003eyears\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.98 [0.93\u0026nbsp;;1.03]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.433\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence to ARV treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.50 [0.31\u0026nbsp;;0.82]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.49 [0.29\u0026nbsp;;0.82]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCD4, cells/mm3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLess than 200\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBetween 200 and 500\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMore than 500\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.93 [0.54\u0026nbsp;;1.61]\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e0.78 [0.45\u0026nbsp;;1.36]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVirological failure (\u0026gt;1000copies/mm3)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.17 [0.52\u0026nbsp;;2.60]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.704\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexually active *\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e2.09 [1.45\u0026nbsp;;3.01]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1.69 [1.12\u0026nbsp;;2.55]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u0026nbsp;\u003c/strong\u003e\u003cem\u003eduring the last 3 months\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"psychoactive substance, PLHIV, Togo","lastPublishedDoi":"10.21203/rs.3.rs-7704826/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7704826/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePsychoactive substance (PAS) use among people living with HIV (PLHIV) can adversely affect treatment adherence, disease progression, and mental health. Despite growing concern, there is limited data on the prevalence and correlates of substance use in this population in Togo. This study aimed to assess the prevalence, patterns, and associated factors of PAS use among PLHIV in Lom\u0026eacute;.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was conducted between August and October among PLHIV attending HIV clinic of the infectious and tropical diseases department of the CHU Sylvanus Olympio in Lom\u0026eacute;. Data were collected using a structured, pre-tested questionnaire administered through face-to-face interviews. Information was gathered on sociodemographic characteristics, ART adherence, and use of PAS (alcohol, tobacco, cannabis, others). Multivariable logistic regression analysis was used to determine factors associated with substance use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 510 PLHIV were included in this study, of which 71.6% were women. Their average age was 48.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 years, and 38.4% had reported the consumption of any PAS. In the multivariable analysis, the age of PLHIV (40 and 49 years old: aOR\u0026thinsp;=\u0026thinsp;0.57; p\u0026thinsp;=\u0026thinsp;0.043; ref = \u0026ldquo;Less than 40 years old\u0026rdquo;); the female sex (aOR\u0026thinsp;=\u0026thinsp;0.36; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); level of education (primary level of education: aOR\u0026thinsp;=\u0026thinsp;0.63; p\u0026thinsp;=\u0026thinsp;0.041; ref = \u0026ldquo;secondary or higher level\u0026rdquo;); religion (Christian: aOR\u0026thinsp;=\u0026thinsp;0.44; p\u0026thinsp;=\u0026thinsp;0.020; Muslim: aOR\u0026thinsp;=\u0026thinsp;0.17; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; ref= \u0026ldquo;none or practicing a traditional religion\u0026rdquo;); adherence to ARV treatment (aOR\u0026thinsp;=\u0026thinsp;0.49; p\u0026thinsp;=\u0026thinsp;0.008) and being sexually active at the time (aOR\u0026thinsp;=\u0026thinsp;1.69; p\u0026thinsp;=\u0026thinsp;0.012) were the factors associated with the consumption of any PAS.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe high prevalence of psychoactive substance use among PLHIV in Lom\u0026eacute; calls for urgent policy and programmatic action. Routine screening, counseling, and integrated interventions should be prioritized to address both substance use and HIV care outcomes.\u003c/p\u003e","manuscriptTitle":"Prevalence, patterns, and associated factors of psychoactive substance use among people living with HIV in Lomé (Togo)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 11:26:42","doi":"10.21203/rs.3.rs-7704826/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-23T06:00:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T10:02:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"340078553356906918800119722666507091349","date":"2025-11-28T19:03:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100441349311632685782813963172685785827","date":"2025-11-28T18:22:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282860445578199956895223988483749678505","date":"2025-10-11T21:18:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T09:06:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51444558901921836537809522564774350681","date":"2025-10-08T11:53:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229165044010119661900367319083382712875","date":"2025-10-08T09:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154298701558510793942229631496322275868","date":"2025-10-08T08:41:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-03T08:17:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-03T08:10:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-03T04:23:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-02T09:54:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-01T15:49:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ef55958-f0e3-47d0-a2b3-e1952baf0c99","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:00:47+00:00","versionOfRecord":{"articleIdentity":"rs-7704826","link":"https://doi.org/10.1186/s12889-026-26751-4","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-03-02 15:57:30","publishedOnDateReadable":"March 2nd, 2026"},"versionCreatedAt":"2025-10-16 11:26:42","video":"","vorDoi":"10.1186/s12889-026-26751-4","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26751-4","workflowStages":[]},"version":"v1","identity":"rs-7704826","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7704826","identity":"rs-7704826","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}