Changes in attitudes toward antiviral medication: a comparison of women living with HIV/AIDS in the pre-HAART and HAART Eras

HIV/AIDS patients' knowledge, attitude, and practice toward anti-retroviral therapy medications' adverse effects and associated factors in Tikur Anbessa Specialized Hospital

Background

Adverse effects (AEs) have been reported with all antiretroviral therapy (ART) medications, and it was among the most common cause for switching or terminating therapy and drug non-adherence. Even though AEs of ART medications are common and to be expected, little study has been conducted on the understanding of patients on the AEs. Therefore, this study aimed to assess patients' knowledge, attitude, and practice (KAP) toward ART medications' AEs and associated factors.

Methods

A cross-sectional study design was applied using an interviewer-administered questionnaire from June to September 2021 on human immunodeficiency virus/acquired immunodeficiency syndrome patients on follow-up at Tikur Anbessa Specialized Hospital, Ethiopia. Data was gathered, cleaned, and analyzed using SPSS version 23. Logistic regression analysis was performed to assess the relationship between the independent variable and patients' knowledge and attitude about the AEs of ART medication. A p-value of 0.05 was used to determine the statistical significance.

Results

About 230 people were enrolled in this study, with 51.3% of them female. Study participants had a mean age of 36 years (standard deviation = 14.19). Of 230 participants, 67.8% had received advice on the AEs of ART medications. Poor knowledge and attitude were observed among 47.8 and 51.3% of respondents, respectively. Prior AEs experience, lack of experiencing opportunistic infection, and lack of counseling about ART medications' AEs were associated with poor knowledge, whereas female gender and a lack of counseling regarding ART medications' AEs were associated with a negative attitude (p < 0.05). Even though most patients (81.7%) report AEs of the medication to professionals, a significant number of patients involved in malpractices such as taking other drugs to treat AEs (24.3%), not prepared to do anything (27.1%), change the suspected drug (24.3%), reduce the dose (18.7%), and use local herbal medicines to treat suspected AEs (20.2%).

Conclusion

Overall, the study participants had poor knowledge, lack of positive attitudes, and non-adherence to the actual recommended practice toward AEs of ART medications. Lack of comorbidity, having prior AEs experience, and lack of counseling regarding ART medication AEs were associated with poor knowledge. Female gender and a lack of counseling on the AEs of ART medications were associated with a negative attitude.

Resilience and Beliefs in the Effectiveness of Current Antiretroviral Therapies Among Recently Disengaged Low-Income People of Color Living with HIV

Consistent antiretroviral adherence is key to viral suppression, but many low-income people of color living with HIV are not optimally adherent due to a wide variety of interrelated social and structural factors. Previous studies have found that HIV medication beliefs are an important facet of adherence. In contrast to the AZT era , currently available antiretroviral therapies are significantly safer and more effective, but research suggests that negative beliefs may persist among racial and ethnic minority people. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in New York City that were currently, or had been recently, disengaged from outpatient HIV medical care. This research suggests that socially and economically marginalized people living with HIV, many long-term survivors who lived through the AZT era, recognized that current treatments are very effective in making HIV a chronic, manageable illness and a significant improvement compared to the therapies early in the epidemic. Most importantly, the data suggests that people demonstrate great resilience despite their experiences of social and economic exclusion. Both clinical practice and public health interventions can benefit from these findings. HIV care providers should speak with patients about their beliefs related to HIV medication, and public health interventions should specifically address HIV medication-related beliefs in order to enhance adherence. In order to avoid reifying people's marginalization, public health should endeavor to recognize and support people's resilience.

Antiretroviral Adherence Trajectories Among Black Americans Living with HIV

Black people living with HIV (BPLWH) are less likely to adhere to antiretroviral treatment than are members of other racial/ethnic groups. Data were combined from two studies of BPLWH (n = 239) to estimate adherence trajectories using a semiparametric, group-based modeling strategy over three time-points (spanning 6 months). Analyses identified three groups of individuals (high-stable, moderately low-stable, low-decreasing). Multinomial logistic regressions were used to predict trajectory membership with multiple levels of socio-ecological factors (structural, institutional/health system, community, interpersonal/network, individual). Older age was associated with being in the high-stable group, whereas substance use, lower perceived treatment effectiveness, and lower quality healthcare ratings were related to being in the moderately low-stable group. In sum, multiple socio-ecological factors contribute to adherence among BPLWH and thus could be targeted in future intervention efforts.

The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis

Poor adherence remains a major barrier to achieving the clinical and public health benefits of antiretroviral drugs (ARVs). A systematic review and qualitative meta-synthesis was conduct to evaluate how ARV adverse drug reactions may influence ARV adherence. Thirty-nine articles were identified, and 33 reported that ARV adverse drug reactions decreased adherence and six studies found no influence. Visually noticeable adverse drug reactions and psychological adverse reactions were reported as more likely to cause non-adherence compared to other adverse drug reactions. Six studies reported a range of adverse reactions associated with EFV-containing regimens contributing to decreased adherence. Informing HIV-infected individuals about ARV adverse drug reactions prior to initiation, counselling about coping mechanisms, and experiencing the effectiveness of ARVs on wellbeing may improve ARV adherence.

Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men

We conducted the first study to examine health correlates of discrimination due to race/ethnicity, HIV-status, and sexual orientation among 348 HIV-positive Black (n = 181) and Latino (n = 167) men who have sex with men. Participants completed audio computer-assisted self-interviews. In multivariate analyses, Black participants who experienced greater racial discrimination were less likely to have a high CD4 cell count [OR = 0.7, 95 % CI = (0.5, 0.9), p = 0.02], and an undetectable viral load [OR = 0.8, 95 % CI = (0.6, 1.0), p = 0.03], and were more likely to visit the emergency department [OR = 1.3, 95 % CI = (1.0, 1.7), p = 0.04]; the combined three types of discrimination predicted greater AIDS symptoms [F (3,176) = 3.8, p < 0.01]. Among Latinos, the combined three types of discrimination predicted greater medication side effect severity [F (3,163) = 4.6, p < 0.01] and AIDS symptoms [F (3,163) = 3.1, p < 0.05]. Findings suggest that the stress of multiple types of discrimination plays a role in health outcomes.

Psychosocial and behavioural correlates of attitudes towards antiretroviral therapy (ART) in a sample of South African mineworkers

Despite being one of the worst affected sectors in South Africa, the mining sector has proven to be one of the most active in intervention efforts in the fight against HIV and AIDS (Ellis, 2007). Owing to low uptake rates of antiretroviral therapy (ART) in mining companies in recent years (Connelly & Rosen, 2006) and the positive relationship between attitudes towards ART and ART uptake (Cooper et al., 2002; Horne, Cooper, Gellaitry, Leake, & Fisher, 2007), this study sought to describe and investigate the psychosocial and behavioural correlates of attitudes towards ART in a sample of South African mineworkers. A total of 806 mineworkers from a large South African mine participated in this quantitative study. Despite a high rate of HIV testing behaviour (83.0%) as well as favourable attitudes towards ART, analysis indicated that temporary employees and contractors were more vulnerable in terms of HIV risk, HIV testing behaviours and ART knowledge and attitudes. Employees who had more positive attitudes towards ART were more knowledgeable of ART and, importantly, had a more favourable attitude towards the mine's HIV/AIDS treatment programme. These findings are discussed in relation to the low ART uptake rates in this context and recommendations for the improvement of ART uptake amongst employees at this mining site.

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.

Bayesian data augmentation methods for the synthesis of qualitative and quantitative research findings

The possible utility of Bayesian methods for the synthesis of qualitative and quantitative research has been repeatedly suggested but insufficiently investigated. In this project, we developed and used a Bayesian method for synthesis, with the goal of identifying factors that influence adherence to HIV medication regimens. We investigated the effect of 10 factors on adherence. Recognizing that not all factors were examined in all studies, we considered standard methods for dealing with missing data and chose a Bayesian data augmentation method. We were able to summarize, rank, and compare the effects of each of the 10 factors on medication adherence. This is a promising methodological development in the synthesis of qualitative and quantitative research.

Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among african american men with HIV

BACKGROUND

Medical mistrust is prevalent among African Americans and may influence health care behaviors such as treatment adherence. We examined whether a specific form of medical mistrust-HIV conspiracy beliefs (eg, HIV is genocide against African Americans)-was associated with antiretroviral treatment nonadherence among African American men with HIV.

METHODS

On baseline surveys, 214 African American men with HIV reported their agreement with 9 conspiracy beliefs, sociodemographic characteristics, depression symptoms, substance use, disease characteristics, medical mistrust, and health care barriers. Antiretroviral medication adherence was monitored electronically for one month postbaseline among 177 men in the baseline sample.

RESULTS

Confirmatory factor analysis revealed 2 distinct conspiracy belief subscales: genocidal beliefs (eg, HIV is manmade) and treatment-related beliefs (eg, people who take antiretroviral treatments are human guinea pigs for the government). Both subscales were related to nonadherence in bivariate tests. In a multivariate logistic regression, only treatment-related conspiracies were associated with a lower likelihood of optimal adherence at one-month follow-up (odds ratio = 0.60, 95% confidence interval = 0.37 to 0.96, P < 0.05).

CONCLUSIONS

HIV conspiracy beliefs, especially those related to treatment mistrust, can contribute to health disparities by discouraging appropriate treatment behavior. Adherence-promoting interventions targeting African Americans should openly address such beliefs.

A systematic review comparing antiretroviral adherence descriptive and intervention studies conducted in the USA

We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity.

A Bayesian method for the synthesis of evidence from qualitative and quantitative reports: the example of antiretroviral medication adherence

OBJECTIVES

Bayesian meta-analysis is a frequently cited but very little-used method for synthesizing qualitative and quantitative research findings. The only example published to date used qualitative data to generate an informative prior probability and quantitative data to generate the likelihood. We developed a method to incorporate both qualitative and quantitative evidence in the likelihood in a Bayesian synthesis of evidence about the relationship between regimen complexity and medication adherence.

METHODS

Data were from 11 qualitative and six quantitative studies. We updated two different non-informative prior distributions with qualitative and quantitative findings to find the posterior distribution for the probabilities that a more complex regimen was associated with lower adherence and that a less complex regimen was associated with greater adherence.

RESULTS

The posterior mode for the qualitative findings regarding more complex regimen and lesser adherence (using the uniform prior with Jeffreys' prior yielding highly similar estimates) was 0.588 (95% credible set limits 0.519, 0.663) and for the quantitative findings was 0.224 (0.203, 0.245); due to non-overlapping credible sets, we did not combine them. The posterior mode for the qualitative findings regarding less complex regimen and greater adherence was 0.288 (0.214, 0.441) and for the quantitative findings was 0.272 (0.118, 0.437); the combined estimate was 0.299 (0.267, 0.334).

CONCLUSIONS

The utility of Bayesian methods for synthesizing qualitative and quantitative research findings at the participant level may depend on the nature of the relationship being synthesized and on how well the findings are represented in the individual reports.

Transforming verbal counts in reports of qualitative descriptive studies into numbers

Reports of qualitative studies typically do not offer much information on the numbers of respondents linked to any one finding. This information may be especially useful in reports of basic, or minimally interpretive, qualitative descriptive studies focused on surveying a range of experiences in a target domain, and its lack may limit the ability to synthesize the results of such studies with quantitative results in systematic reviews. Accordingly, the authors illustrate strategies for deriving plausible ranges of respondents expressing a finding in a set of reports of basic qualitative descriptive studies on antiretroviral adherence and suggest how the results might be used. These strategies have limitations and are never appropriate for use with findings from interpretive qualitative studies. Yet they offer a temporary workaround for preserving and maximizing the value of information from basic qualitative descriptive studies for systematic reviews. They show also why quantitizing is never simply quantitative.

"When in the body, it makes you look fat and HIV negative": the constitution of antiretroviral therapy in local discourse among youth in Kahe, Tanzania

Antiretroviral therapy (ART) is becoming increasingly more accessible within the health care system in Tanzania. However, the impact of the increased availability of ART on local conceptions about medicines, health and physical wellbeing has not been fully explored. In this article we examine how ART is constituted within local discourses about treatment and healing. Based on 21 focus group discussions with young people aged 14-24 years in a rural area (Kahe), we examine how local terms and descriptions of antiretroviral therapy relate to wider definitions about the body, health, illness and drug efficacy. Findings illustrate how local understandings of ART draw on a wider discourse about the therapeutic functions of medicines and clinical dimensions of HIV/AIDS. Therapeutic efficacy of antiretroviral medication appeared to overlap and sometimes contradict locally shared understandings of the clinical functions of medicines in the body. Implications of ART on bodily appearance and HIV signs may influence conceptions about sick role, perpetuate stigma and affect local strategies for HIV prevention. Structural inequities in access, limited information on therapeutic efficacy of ART and perceived difficulties with status disclosure appear to inform local conceptions and possible implications of ART. Policy and programme interventions to foster public understanding and acceptability of ART should emphasize treatment education about the benefits and limitations of therapy and increased access to ART in rural areas, and should integrate voluntary status disclosure and HIV prevention.

Gender differences in patterns of HIV service use in a national sample of HIV-positive Australians

There have been clear gender differences in the experience of living with HIV in Australia since the start of the epidemic. This paper examines the patterns of health service use and experiences at those services over a period of six years. The results reported here are drawn from the HIV Futures surveys, four consecutive national, cross-sectional Australian surveys of the lives of PLWHA. Women were found to use different medical services to men both for non HIV-related and HIV-related treatment, being more likely to use generalist services and hospital-based HIV specialists. Women also reported higher rates of discrimination at health services, however reports of new incidences of discrimination were found to decrease from 2001 onwards. Although women reported higher levels of unwanted disclosure of HIV status than men, particularly by health care workers, new reports of unwanted disclosure decreased between 2003 and 2005. These data indicate that there are long-term gender differences in medical service use by PLWHA in Australia, and that this has been associated with higher rates of discrimination and loss of confidentiality for women. However the decrease in new reports of discrimination over time indicates that improved education of health service providers has been successful.

Making Sense of Qualitative and Quantitative Findings in Mixed Research Synthesis Studies

The synthesis of qualitative and quantitative research findings is increasingly promoted, but many of the conceptual and methodological issues it raises have yet to be fully understood and resolved. In this article, we describe how we handled issues encountered in efforts to synthesize the findings in forty-two reports of studies of antiretroviral adherence in HIV-positive women in the course of an ongoing study to develop methods to synthesize qualitative and quantitative research findings in common domains of health-related research. Working with these reports underscored the importance of looking past method claims and ideals and directly at the findings themselves, differentiating between aggregative syntheses in which findings are assimilated and interpretive syntheses in which they are configured, and understanding the judgments involved in designating relationships between findings as confirmatory, divergent, or complementary.

Racial differences in virologic failure associated with adherence and quality of life on efavirenz-containing regimens for initial HIV therapy: results of ACTG A5095

BACKGROUND

Blacks had higher rates of virologic failure than whites on efavirenz-containing regimens in the AIDS Clinical Trials Group (ACTG) A5095 study; preliminary analyses also suggested an association with adherence. We rigorously examined associations over time among race, virologic failure, 4 self-reported adherence metrics, and quality of life (QOL).

METHODS

ACTG A5095 was a double-blind placebo-controlled study of treatment-naive HIV-positive patients randomized to zidovudine/lamivudine/abacavir versus zidovudine/lamivudine plus efavirenz versus zidovudine/lamivudine/abacavir plus efavirenz. Virologic failure was defined as confirmed HIV-1 RNA >or=200 copies/mL at >or=16 weeks on study. The zidovudine/lamivudine/abacavir arm was discontinued early because of virologic inferiority. We examined virologic failure differences for efavirenz-containing arms according to missing 0 (adherent) versus at least 1 dose (nonadherent) during the past 4 days, alternative self-reported adherence metrics, and QOL. Analyses used the Fisher exact, log rank tests, and Cox proportional hazards models.

RESULTS

The study population included white (n = 299), black (n = 260), and Hispanic (n = 156) patients with >or=1 adherence evaluation. Virologic failure was associated with week 12 nonadherence during the past 4 days for blacks (53% nonadherent failed vs. 25% adherent; P < 0.001) but not for whites (20% nonadherent failed vs. 20% adherent; P = 0.91). After adjustment for baseline covariates and treatment, there was a significant interaction between race and week 12 adherence (P = 0.02). In time-dependent Cox models using self-reports over time to reflect recent adherence, there was a significantly higher failure risk for nonadherent subjects (hazard ratio [HR] = 2.07; P < 0.001). Significant race-adherence interactions were seen in additional models of adherence: missing at least 1 medication dose ever (P = 0.04), past month (P < 0.01), or past weekend (P = 0.05). Lower QOL was significantly associated with virologic failure (P < 0.001); there was no evidence of an interaction between QOL and race (P = 0.39) or adherence (P = 0.51) in predicting virologic failure.

CONCLUSIONS

There was a greater effect of nonadherence on virologic failure in blacks given efavirenz-containing regimens than in whites. Self-reported adherence and QOL are independent predictors of virologic failure.

The Relationship Between Spirituality, Purpose in Life, and Well-Being in HIV-Positive Persons

Research has shown that spirituality has a positive effect on mental and physical health; however, few studies have explored the influence of spirituality on purpose in life and well-being in persons living with HIV. This descriptive cross-sectional study was designed to examine the relationship between spirituality, purpose in life, and well-being in a sample of 46 HIV-positive men and women. Spirituality was measured using the Spiritual Involvement and Beliefs Scale-Revised (SIBS-R), purpose in life was measured using the Purpose in Life (PIL) test, and well-being was measured using the General Well-Being (GWB) Schedule. Demographic data on gender, age, length of time living with diagnosis of HIV/AIDS, employment status, and religious affiliation were also collected. Spirituality was reported to be significantly correlated with purpose in life (r = .295, p = .049) but not with well-being (r = .261, p = .084). Additionally, the SIBS-R, PIL, and GWB had alpha coefficients greater than .83, suggesting they are reliable and valid measures for this population of HIV-positive persons. The result that spirituality and purpose in life were significantly correlated offers the potential for designing nursing interventions and care delivery approaches that support psychological adaptation to HIV. Further studies with larger and more diverse samples are needed to better understand the role of well-being in healing.

Using qualitative metasummary to synthesize qualitative and quantitative descriptive findings

The new imperative in the health disciplines to be more methodologically inclusive has generated a growing interest in mixed research synthesis, or the integration of qualitative and quantitative research findings. Qualitative metasummary is a quantitatively oriented aggregation of qualitative findings originally developed to accommodate the distinctive features of qualitative surveys. Yet these findings are similar in form and mode of production to the descriptive findings researchers often present in addition to the results of bivariate and multivariable analyses. Qualitative metasummary, which includes the extraction, grouping, and formatting of findings, and the calculation of frequency and intensity effect sizes, can be used to produce mixed research syntheses and to conduct a posteriori analyses of the relationship between reports and findings.

Differences in adherence and motivation to HIV therapy--two independent assessments in 1998 and 2002

OBJECTIVE

The aim of this study was to compare the level of adherence and motivation in two independent cross-sectional samples of HIV-infected patients conducted in 1998 and 2002, and to investigate the relationship between adherence and motivation.

METHOD

Consecutive HIV-infected patients on treatment at a Swedish clinic were asked to complete an anonymous questionnaire. In 1998, 60 patients participated and in 2002, 53 participated. In 2002, the 9-item Morisky Medication Adherence Scale (MMAS) was added to the questionnaire set.

MAIN OUTCOME MEASURE

Self-reported adherence and motivation.

RESULTS

In 1998, 28.1% of the respondents were considered adherent, while the corresponding proportion was 57.4% in 2002 (P = 0.002). The mean summary score for MMAS was 10.7 in 2002 (13 = perfect adherence). The proportion considered motivated were 22.4% in the 1998 survey and 41.3% in 2002 (P = 0.038). Of the respondents considered motivated in the 2002 survey, 46.7% scored the maximum summary score on the MMAS, while 8.7% of the non-motivated respondents did so (P = 0.016).

CONCLUSION

The respondents in 2002 were more adherent and motivated than the respondents in 1998 and a relationship between motivation and adherence was found. The difference in adherence and motivation might be due to a new treatment model at the clinic.

Research results have expiration dates: ensuring timely systematic reviews

Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.

Becoming Adherent: Experiences of Persons Living With HIV/AIDS

Interviews were conducted with HIV-infected persons who had been taking antiretroviral medications for 6 months, reported high levels of adherence, and had low or stable viral loads consistent with adherence. Analysis of the qualitative data revealed five themes related to adherence. "Choosing life" was reflected in decisions about initiating treatment, changing one's lifestyle, and pursuing goals. "Riding it out" emerged from descriptions of adjusting to side effects and overcoming barriers to adherence. "Figuring it out" encompassed individual strategies for incorporating pill-taking into one's life, such as use of pillboxes and making a schedule. "Sticking to it" was overcoming internal resistance to maintaining adherence. "Realizing the benefits," the final theme, revealed successful adherers who had improved clinical outcomes and for whom pill-taking had become routine.