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Castelan A, Nellen JF, van der Valk M, Nieuwkerk PT. Intentional- but not Unintentional Medication Non-adherence was Related with Beliefs about Medicines Among a Multi-Ethnic Sample of People with HIV. AIDS Behav 2023; 27:1045-1054. [PMID: 36056998 PMCID: PMC9440648 DOI: 10.1007/s10461-022-03842-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/24/2022]
Abstract
Medication non-adherence can be intentional or unintentional. We investigated the prevalence of unintentional and intentional non-adherence to antiretroviral therapy (ART) and the relationship with beliefs about medicines, sociodemographic- and HIV-related variables among people with HIV (PWH) attending the HIV clinic of the Amsterdam University Medical Centers. Participants completed the Medication Adherence Rating Scale (MARS) and the Beliefs about Medicines (BMQ) questionnaire. About half of 80 participants reported unintentional non-adherence and 20% reported intentional non-adherence. Both unintentional and intentional non-adherence were associated with younger age. Additionally, intentional non-adherence was associated with being a migrant from Suriname /Netherlands Antilles, having more concerns about negative effects of ART and stronger beliefs that medicines in general are overused/ overprescribed. In conclusion, intentional but not unintentional non-adherence was associated with beliefs about medicines. Eliciting and discussing beliefs about medicines may be a promising avenue to address patients' concerns and perceptions thereby potentially enhancing medication adherence.
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Affiliation(s)
- Anjuly Castelan
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Jeannine F Nellen
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marc van der Valk
- Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location AMC, University of Amsterdam, J3-219-1), Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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2
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Sleep Disturbance is Associated with Missing PrEP Doses Among Young Black Sexual Minority Men in The N2 study. AIDS Behav 2022; 26:3827-3833. [PMID: 35661017 PMCID: PMC10109514 DOI: 10.1007/s10461-022-03711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
PrEP uptake and adherence among young Black sexual minority men (YBSMM), has been sub-optimal. Multiple studies identified sleep as an important determinant of medication adherence, although it has not been examined with regard to PrEP among YBSMM. This study utilized data collected from HIV-negative cisgender YBSMM in the Neighborhoods and Networks (N2) study in Chicago using PrEP (N = 70). Sleep quality was measured using the PHQ-9 and PrEP adherence questions were adapted from Reynolds et al., 2004. Bivariate and multivariable regression analyses were used to estimate associations between sleep and missing PrEP doses, controlling for relevant demographic and behavioral factors. YBSMM who reported sleep disturbance a moderate amount of time (aOR 7.59 [1.05 to 54.57]) were more likely to miss taking PrEP because they had too many pills to take. Sleep quality is an overlooked determinant of medication adherence, and may negatively impact YBSMM's ability to consistently take PrEP.
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Aung S, Hardy N, Chrysanthopoulou S, Htun N, Kyaw A, Tun MS, Aung KW, Kantor R, Rana A. Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers. AIDS Care 2022; 34:762-770. [PMID: 33749465 PMCID: PMC10715989 DOI: 10.1080/09540121.2021.1902929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
In Myanmar, an Asian country with one of the highest HIV-1 prevalence rates, counseling prior to initiating antiretroviral therapy (ART) is standard care, either by a healthcare worker (standard counselor, SC) or trained counselor who is also living with HIV (peer counselor, PC). PC is commonly utilized in Myanmar and other resource-limited settings. However, its benefit over SC is unclear. We conducted a cross-sectional survey of people living with HIV (PLWH), who completed either only PC or only SC before treatment initiation across four cities in Myanmar. Participants were evaluated for HIV knowledge, stigma, antiretroviral adherence, barriers to care, social support satisfaction and attitudes regarding both counseling processes. Bivariate analyses and multivariable mixed effects modeling were conducted to compare differences in these measures among PC and SC participants. Among 1006 participants (49% PC; 51% SC), 52% were females and median age was 37 years in those receiving PC and 40 years in those receiving SC. More than 70% of participants in both groups achieved up to grade school education. The average duration since HIV diagnosis was 4.6 years for PC and 5.7 years for SC participants. HIV knowledge and attitudes regarding counseling were good in both groups and more PC participants credited their HIV counselor for knowledge (75% vs 63%, p < 0.001). Compared to SC, PC participants had lower enacted stigma (Incidence Rate Ratio (IRR) 0.75, Confidence Interval (CI) [0.65, 0.86]), mean internalized stigma (-0.24, CI [-0.34, -0.14]), and risk of antiretroviral therapy non-adherence (Odds Ratio 0.59, CI [0.40, 0.88]), while reporting higher levels of barriers to care (9.63, CI [8.20, 11.75]). Our findings demonstrate potential benefits of PC compared to SC, and support the utilization of PC to enhance HIV health outcomes within the unique societal and geographical context of Myanmar, and possibly beyond.
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Affiliation(s)
- Su Aung
- Division of Infectious Diseases, University of California San Francisco, California, CA (USA)
| | - Nicole Hardy
- School of Public Health, Brown University, Providence, RI, United States
| | | | | | - Aung Kyaw
- National AIDS Programme, Yangon, Myanmar
| | | | | | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI (USA)
| | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham School of Medicine, Birmingham, AL (USA)
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Labisi TO, Podany AT, Fadul NA, Coleman JD, King KM. Factors associated with viral suppression among cisgender women living with human immunodeficiency virus in the United States: An integrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221092267. [PMID: 35435055 PMCID: PMC9019389 DOI: 10.1177/17455057221092267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. OBJECTIVES This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. METHODS We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. RESULTS Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. CONCLUSION Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre-post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.
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Affiliation(s)
- Titilola O Labisi
- Department of Health Promotion and Disease Prevention, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony T Podany
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nada A Fadul
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jason D Coleman
- School of Health and Kinesiology, University of Nebraska Omaha, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion and Disease Prevention, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Aung S, Hardy N, Chrysanthopoulou SA, Kyaw A, Tun MS, Aung KW, Rana A, Kantor R. Stigma Determines Antiretroviral Adherence in Adults With HIV in Myanmar. J Acquir Immune Defic Syndr 2022; 89:19-26. [PMID: 34542090 PMCID: PMC8675909 DOI: 10.1097/qai.0000000000002813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Understanding social and structural barriers that determine antiretroviral therapy (ART) adherence can improve care. Assessment of such factors is limited in Myanmar, a country with high HIV prevalence and increasing number of people living with HIV initiating ART. METHODS Questionnaires were administered to adults with HIV across 4 Myanmar cities to estimate adherence and its potential determinants, including HIV knowledge, social support, barriers to care, enacted and internalized stigma, and engagement in peer-to-peer HIV counseling (PC). Associations were determined using logistic mixed-effects modeling. RESULTS Among 956 participants, the mean age was 39 years, 52% were female, 36% had CD4 <350 cells/mm3, and 50% received pre-ART PC. Good adherence was reported by 74% of participants who had better HIV knowledge than those reporting nonadherence. Among nonadherent, 44% were forgetful and 81% were careless about taking ART. Among all participants, most (53%) were very satisfied with their social support and 79% reported lack of financial resources as barriers to care. Participants most frequently reported being viewed differently by others (30%) and feeling as if they were paying for past karma or sins because of their HIV diagnosis (66%). Enacted stigma (odds ratio 0.86; 95% confidence interval 0.79 to 0.92, P < 0.01) and internalized stigma (odds ratio 0.73; 95% confidence interval: 0.56 to 0.95, P = 0.023) were associated with worse adherence. CONCLUSIONS Increased self-reported ART adherence in Myanmar is associated with less enacted and internalized stigma. These findings suggest the benefit of developing and promoting adherence interventions, which are focused on mitigating HIV-related stigma in the county.
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Affiliation(s)
- Su Aung
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, United States of America
| | - Nicole Hardy
- School of Public Health, Brown University, Providence, RI, United States of America
| | | | - Aung Kyaw
- National AIDS Programme, Yangon, Myanmar
| | | | | | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham School of Medicine, Birmingham, AL, United States of America
| | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, United States of America
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Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence. J Acquir Immune Defic Syndr 2017; 76:482-487. [PMID: 28885270 DOI: 10.1097/qai.0000000000001543] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes are unclear. METHODS Among 196 HIV clinic patients in Birmingham, AL, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariate-adjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence and the mediating role of visit adherence in the association between internalized stigma and ART adherence. RESULTS Higher internalized stigma was associated with lower visit adherence (B = -0.04, P = 0.04). Black (versus white) race and depressive symptoms were other significant predictors within this model. Mediation analysis yielded no indirect effect through depression in the association between internalized stigma and visit adherence (B = -0.18, SE = 0.11, 95% confidence interval: -0.44 to -0.02) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the effect of internalized stigma on suboptimal ART adherence was mediated by lower visit adherence (B = -0.18, SE = 0.11, 95% confidence interval: -0.44 to -0.02). CONCLUSIONS Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.
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Corless IB, Hoyt AJ, Tyer-Viola L, Sefcik E, Kemppainen J, Holzemer WL, Eller LS, Nokes K, Phillips JC, Dawson-Rose C, Rivero-Mendez M, Iipinge S, Chaiphibalsarisdi P, Portillo CJ, Chen WT, Webel AR, Brion J, Johnson MO, Voss J, Hamilton MJ, Sullivan KM, Kirksey KM, Nicholas PK. 90-90-90-Plus: Maintaining Adherence to Antiretroviral Therapies. AIDS Patient Care STDS 2017; 31:227-236. [PMID: 28514193 DOI: 10.1089/apc.2017.0009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Medication adherence is the "Plus" in the global challenge to have 90% of HIV-infected individuals tested, 90% of those who are HIV positive treated, and 90% of those treated achieve an undetectable viral load. The latter indicates viral suppression, the goal for clinicians treating people living with HIV (PLWH). The comparative importance of different psychosocial scales in predicting the level of antiretroviral adherence, however, has been little studied. Using data from a cross-sectional study of medication adherence with an international convenience sample of 1811 PLWH, we categorized respondent medication adherence as None (0%), Low (1-60%), Moderate (61-94%), and High (95-100%) adherence based on self-report. The survey contained 13 psychosocial scales/indices, all of which were correlated with one another (p < 0.05 or less) and had differing degrees of association with the levels of adherence. Controlling for the influence of race, gender, education, and ability to pay for care, all scales/indices were associated with adherence, with the exception of Berger's perceived stigma scale. Using forward selection stepwise regression, we found that adherence self-efficacy, depression, stressful life events, and perceived stigma were significant predictors of medication adherence. Among the demographic variables entered into the model, nonwhite race was associated with double the odds of being in the None rather than in the High adherence category, suggesting these individuals may require additional support. In addition, asking about self-efficacy, depression, stigma, and stressful life events also will be beneficial in identifying patients requiring greater adherence support. This support is essential to medication adherence, the Plus to 90-90-90.
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Affiliation(s)
- Inge B Corless
- 1 MGH Institute of Health Professions School of Nursing , Boston, Massachusetts
| | - Alex J Hoyt
- 1 MGH Institute of Health Professions School of Nursing , Boston, Massachusetts
| | | | | | - Jeanne Kemppainen
- 4 University of North Carolina-Wilmington School of Nursing , Wilmington, North Carolina
| | | | | | - Kathleen Nokes
- 6 Hunter-Bellevue School of Nursing , CUNY, New York, New York
| | | | | | | | | | | | | | - Wei-Ti Chen
- 12 School of Nursing, Yale University , New Haven, Connecticut
| | - Allison R Webel
- 13 Bolton School of Nursing, Case Western University , Cleveland, Ohio
| | - John Brion
- 14 College of Nursing, The Ohio State University , Columbus, Ohio
| | | | - Joachim Voss
- 13 Bolton School of Nursing, Case Western University , Cleveland, Ohio
| | | | | | | | - Patrice K Nicholas
- 1 MGH Institute of Health Professions School of Nursing , Boston, Massachusetts
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Cuca YP, Asher A, Okonsky J, Kaihura A, Dawson-Rose C, Webel A. HIV Stigma and Social Capital in Women Living With HIV. J Assoc Nurses AIDS Care 2016; 28:45-54. [PMID: 27697368 DOI: 10.1016/j.jana.2016.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
Abstract
Women living with HIV (WLWH) continue to experience HIV-related stigma. Social capital is one resource that could mitigate HIV stigma. Our cross-sectional study examined associations between social capital and HIV-related stigma in 135 WLWH in the San Francisco Bay Area. The mean age of study participants was 48 years; 60% were African American; 29% had less than a high school education; and 19% were employed. Age was significantly associated with perceived HIV stigma (p = .001), but total social capital was not. Women with lower Value of Life social capital scores had significantly higher total stigma scores (p = .010) and higher Negative Self-image stigma scores (p = .001). Women who felt less valued in their social worlds may have been more likely to perceive HIV stigma, which could have negative health consequences. This work begins to elucidate the possible relationships between social capital and perceived HIV stigma.
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Dawson-Rose C, Cuca YP, Webel AR, Solís Báez SS, Holzemer WL, Rivero-Méndez M, Eller LS, Reid P, Johnson MO, Kemppainen J, Reyes D, Nokes K, Nicholas PK, Matshediso E, Mogobe KD, Sabone MB, Ntsayagae EI, Shaibu S, Corless IB, Wantland D, Lindgren T. Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care. J Assoc Nurses AIDS Care 2016; 27:574-84. [PMID: 27080926 PMCID: PMC5207494 DOI: 10.1016/j.jana.2016.03.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/15/2016] [Indexed: 01/23/2023]
Abstract
Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.
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Affiliation(s)
| | - Yvette P. Cuca
- Specialist, UCSF School of Nursing, San Francisco, California, USA
| | - Allison R. Webel
- Assistant Professor, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | | | | | - Paula Reid
- Assistant Professor, University of North Carolina at Wilmington, Wilmington, North Carolina, USA
| | | | - Jeanne Kemppainen
- Professor and Assistant Department Chair, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Darcel Reyes
- Adult Nurse Practitioner, HELP/PSI, Yonkers, New York, USA
| | - Kathleen Nokes
- Professor Emerita, Hunter College and Graduate Center, City University of New York, Stone Ridge, New York, USA
| | - Patrice K. Nicholas
- Professor and Director, Brigham and Women’s Hospital and MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Ellah Matshediso
- Director, HIV and AIDS Coordination Office, University of Botswana, Gaborone, Botswana
| | - Keitshokile Dintle Mogobe
- Associate Professor and Deputy Dean, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | | | - Sheila Shaibu
- Associate Professor, University of Botswana, Gaborone, Botswana
| | - Inge B. Corless
- Professor, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Dean Wantland
- Assistant Professor and Director, Office of Research & Evaluation, Rutgers College of Nursing, Newark, New Jersey, USA
| | - Teri Lindgren
- Assistant Professor & Specialty Director, Community Health Program, Rutgers College of Nursing, Newark, New Jersey, USA
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