1
|
Arnold EM, Kamal S, Rotheram-Borus MJ, Bridges SK, Gertsch W, Norwood P, Swendeman D. Factors Associated With Antiretroviral Adherence Among Youth Living With HIV. J Acquir Immune Defic Syndr 2024; 95:215-221. [PMID: 37977178 PMCID: PMC10922292 DOI: 10.1097/qai.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Youth living with HIV (YLH) have an increased risk for psychosocial stressors that can affect their antiretroviral (ARV) adherence. We examined factors associated with self-reported ARV adherence among YLH ages 12-24 years old. SETTING YLH (N = 147) were recruited in Los Angeles, CA, and New Orleans, LA from 2017 to 2020. METHODS YLH whose self-reported recent (30 days) ARV adherence was "excellent" or "very good" were compared with nonadherent YLH on sociodemographic, clinical, and psychosocial factors using univariate and multivariate analyses. RESULTS Participants were predominantly male (88%), and 81% identified as gay, bisexual, transgender, queer, or other. The mean duration on ARV was 27 months (range 0-237 months). Most YLH (71.2%) self-reported being adherent, and 79% of those who self-reported adherence were also virally suppressed (<200 copies/mL). Multivariate analysis indicated being adherent was significantly associated with white race [aOR = 8.07, confidence intervals (CI): 1.45 to 74.0], Hispanic/Latinx ethnicity [aOR = 3.57, CI: 1.16 to 12.80], more social support [aOR = 1.11, CI: 1.05 to 1.18], and being on ARV for a shorter duration [aOR = 0.99, CI: 0.97 to 0.99]. Mental health symptoms, substance use, age, and history of homelessness or incarceration were unrelated to adherence. CONCLUSIONS Enhancing efforts to provide support for adherence to non-white youth, and those with limited social support and who have been on ARV treatment longer, may help increase viral suppression among YLH.
Collapse
Affiliation(s)
| | - Susan Kamal
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - S Kate Bridges
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX; and
| | - William Gertsch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Peter Norwood
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Brown MJ, Wu M, Zeng C, Harrison S, Haider MR, Li X. Racial disparities in the association between resilience and ART adherence among people living with HIV: the mediating role of depression. AIDS Care 2022; 34:1555-1564. [PMID: 35254174 PMCID: PMC9448828 DOI: 10.1080/09540121.2022.2049194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2022] [Indexed: 01/26/2023]
Abstract
Research examining the mediating role of depressive symptoms in the association between resilience and antiretroviral therapy (ART) adherence is lacking. Therefore, this study aims to examine the mediating role of depression between resilience and ART adherence, as well as to explore whether this relationship varies across racial background. A total of 327 people living with HIV and on ART in South Carolina were surveyed about their ART adherence and mental health, including resilience and depressive symptoms. Path analyses were conducted to determine the direct and indirect effects between resilience, depressive symptoms, and ART adherence. After adjusting for age, gender, income, education, employment and time since diagnosis, among Black individuals, resilience was negatively associated with depressive symptoms (β = --0.248, p < 0.001); depressive symptoms were negatively associated with ART adherence (β = -0.166, p = 0.020); however, resilience was not significantly associated with ART adherence. Among White individuals, there was no statistically significant association. The indirect effect between resilience and ART adherence through depressive symptoms was statistically significant (β = 0.041, p = 0.040) for Black individuals, while not statistically significant for White individuals (β = 0.024, p = 0.578). Interventions aimed at improving ART adherence, which attenuate depressive symptoms through accentuating resilience may be especially beneficial for Black populations living with HIV.
Collapse
Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Miao Wu
- Nanjing Medical University, Jiangsu, China
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Psychology, College of Arts and Sciences, University of South Carolina
| | - Mohammad Rifat Haider
- Health Policy and Management, College of Public Health, University of Georgia, Athens GA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
4
|
Orkin C, Cahn P, Castagna A, Emu B, Harrigan P, Kuritzkes DR, Nelson M, Schapiro J. Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment-limited individuals living with HIV. HIV Med 2022; 23:936-946. [PMID: 35293094 PMCID: PMC9546304 DOI: 10.1111/hiv.13288] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Entry inhibitors are a relatively new class of antiretroviral therapy and are typically indicated in heavily treatment experienced individuals living with HIV. Despite this, there is no formal definition of 'heavily treatment experienced'. Interpretation of this term generally includes acknowledgement of multidrug resistance and reflects the fact that patients in need of further treatment options may have experienced multiple lines of therapy. However, it fails to recognize treatment limiting factors including contraindications, age-associated comorbidities, and difficulty adhering to regimens. METHODS This manuscript follows a roundtable discussion and aims to identify the unmet needs of those living with HIV who are in need of further treatment options, to broaden the definition of heavily treatment experienced and to clarify the use of newer agents, with an emphasis on the potential role of entry inhibitors, in this population. RESULTS/CONCLUSIONS Within the entry inhibitor class, mechanisms of action differ between agents; resistance to one subclass does not confer resistance to others. Combinations of entry inhibitors should be considered in the same regimen, and if lack of response is seen to one entry inhibitor another can be tried. When selecting an entry inhibitor, physicians should account for patient preferences and needs as well as agent-specific clinical characteristics. Absence of documented multidrug resistance should not exclude an individual from treatment with an entry inhibitor; entry inhibitors are a valuable treatment option for all individuals who are treatment limited or treatment exhausted. We should advocate for additional clinical trials that help define the role of entry inhibitors in people with exhausted/limited ART options other than drug resistance.
Collapse
Affiliation(s)
| | - Pedro Cahn
- Fundacion HuespedBuenos AiresArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
| | - Antonella Castagna
- Vita‐Salute San Raffaele UniversitySan Raffaele Scientific InstituteMilanItaly
| | - Brinda Emu
- Yale School of MedicineNew HavenConnecticutUSA
| | | | | | | | | |
Collapse
|
5
|
Chan RCH, Mak WWS. Protective and Compensatory Effects of Group Identification on the Mental Health of People Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1677-1687. [PMID: 33106924 DOI: 10.1007/s10508-020-01823-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Despite persistent stigmatization of people living with HIV (PLHIV) across the globe, group identification among these individuals may serve to counteract the detrimental effect of prejudice and discrimination associated with the stigmatized identity. Drawing on resilience theory and social identity theory, this study examined how multiple dimensions of group identification (i.e., in-group ties, in-group affect, and centrality) function to buffer and neutralize the negative impact of HIV stigma. A total of 281 PLHIV were recruited from the only community-based public HIV clinic in Hong Kong to participate in this study. The results revealed a protective effect of in-group affect, which moderated the relationship between HIV stigma and mental health, such that HIV stigma was not associated with mental health among people with higher positive in-group affect. In addition, a positive compensatory effect of in-group ties was found in people with higher HIV identity centrality. Given the protective effect of in-group affect, it is important to re-story the lives among PLHIV by challenging their maladaptive beliefs about being PLHIV and building a positive sense of identity in their personal narratives. Community-based interventions should be provided to individuals with higher HIV identity centrality by offering peer support groups and engaging them in community work.
Collapse
Affiliation(s)
- Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| |
Collapse
|
6
|
Nutor JJ, Slaughter-Acey JC, Marquez SP, DiMaria-Ghalili RA, Momplaisir F, Oladimeji KE, Jemmott LS. Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia. BMC Public Health 2020; 20:1410. [PMID: 32938415 PMCID: PMC7495861 DOI: 10.1186/s12889-020-09505-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia. METHODS We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART. RESULTS Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality. CONCLUSION Compared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.
Collapse
Affiliation(s)
- Jerry John Nutor
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA, 94143-0608, USA.
| | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Shannon P Marquez
- Undergraduate Global Engagement, Columbia University, New York City, NY, 110027, USA
| | | | - Florence Momplaisir
- Department of Medicine, Hospital of University of the Pennsylvania, Philadelphia, PA, 19102, USA
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Alice, Eastern Cape, South Africa
| | - Loretta S Jemmott
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19104, USA
| |
Collapse
|
7
|
The Moderating Role of Social Support on the Relationship Between Anxiety, Stigma, and Intention to Use Illicit Drugs Among HIV-Positive Men Who Have Sex with Men. AIDS Behav 2020; 24:55-64. [PMID: 31754966 DOI: 10.1007/s10461-019-02719-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The present study examined the association between anxiety, stigma, social support and intention to use illicit drugs, and the moderating role of social support on the association between anxiety/stigma and intention to use illicit drugs among 450 Chinese HIV-positive MSM. Findings show that controlling for significant background variables, self-stigma and anxiety were positively associated with intention to use illicit drugs, while social support was negatively associated with intention to use illicit drugs. A significant moderation effect of social support was also observed, that the negative association between self-stigma/anxiety and intention to use illicit drugs was only significant among participants with lower levels of social support. Findings highlight the importance of reducing self-stigma and anxiety, and promoting social support in drug use prevention for HIV-positive MSM.
Collapse
|
8
|
Rintamaki L, Kosenko K, Hogan T, Scott AM, Dobmeier C, Tingue E, Peek D. The Role of Stigma Management in HIV Treatment Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5003. [PMID: 31835334 PMCID: PMC6950713 DOI: 10.3390/ijerph16245003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence.
Collapse
Affiliation(s)
- Lance Rintamaki
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Kami Kosenko
- Department of Communication, North Carolina State University, Raleigh, NC 27695, USA;
| | - Timothy Hogan
- Center for Healthcare Organization & Implementation Research, United States Department of Veterans Affairs, Bedford, MA 01730, USA;
- Department of Population and Data Sciences, University of Texas, Southwestern, Dallas, TX 75390, USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, Lexington, KY 40506, USA;
| | - Christopher Dobmeier
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Erik Tingue
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - David Peek
- Department of Medicine, Pen Bay Medical Center, Rockport, ME 04856, USA;
| |
Collapse
|
9
|
Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, Hogan JW, Carey MP, Howe CJ. Resilience and HIV: a review of the definition and study of resilience. AIDS Care 2019; 30:S6-S17. [PMID: 30632778 DOI: 10.1080/09540121.2018.1515470] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.
Collapse
Affiliation(s)
- Akilah J Dulin
- a Center for Health Equity Research, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Sannisha K Dale
- b Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Valerie A Earnshaw
- c Department of Human Development and Family Sciences , University of Delaware , Newark , DE , USA
| | - Joseph L Fava
- d Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Michael J Mugavero
- e Division of Infectious Diseases, Department of Medicine, Center for AIDS Research , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sonia Napravnik
- f Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joseph W Hogan
- g Center for Statistical Sciences, Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Michael P Carey
- h Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior , The Miriam Hospital, Alpert Medical School of Brown University , Providence , RI , USA
| | - Chanelle J Howe
- i Centers for Epidemiology and Environmental Health, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
| |
Collapse
|
10
|
Bright EE, Stanton AL. Correspondence Between Objective and Self-reported Endocrine Therapy Adherence Among Women With Breast Cancer. Ann Behav Med 2018; 53:849-857. [DOI: 10.1093/abm/kay094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AbstractBackgroundAmong the approximately 70% of women with hormone receptor-positive breast cancer, endocrine therapies lower the likelihood of recurrence. Nonadherence to endocrine therapy predicts lower survival.PurposeWe examined concordance between self-reported and objective indicators of adherence and predictors of over-reporting endocrine therapy adherence among survivors of breast cancer.MethodsWomen with breast cancer (N = 112) receiving their initial endocrine therapy prescription completed three assessments at prescription initiation (Time 1), 1 month (Time 2), and 4 months later (Time 3). At Time 1, participants were provided a medication event monitoring system (MEMS) cap to assess adherence; it was collected at Time 3. Women completed items regarding self-reported adherence, depressive symptoms, cancer-related coping processes, and the patient–physician relationship.ResultsMEMS was significantly negatively correlated with the self-reported nonadherence measurements of occasionally forgetting (Time 2, ρ = −.29, p < .01; Time 3, ρ = −.24, p < .01), nonadherence in the past week (Time 2, ρ = −.53, p < .01; Time 3, ρ = −.45, p < .01), and nonadherence in an average week in the past month (Time 2, ρ = −.38, p < .01; Time 3, ρ = −.39, p < .01). Concordance in objective and self-reported adherence measures was evident in 83% of women at Time 2 and 73% at Time 3. Older age was significantly associated (p < .01) with discordance.ConclusionsFindings reveal moderate correspondence between objective and self-report measures, with self-report overestimating objective adherence. Clinicians should be aware when treating older breast cancer survivors that they are more likely to over self-report their endocrine therapy adherence.
Collapse
Affiliation(s)
- Emma E Bright
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
11
|
Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway. AIDS Behav 2018; 22:3166-3174. [PMID: 29572762 DOI: 10.1007/s10461-018-2098-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.
Collapse
|
12
|
Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One 2017; 12:e0186458. [PMID: 29040335 PMCID: PMC5645121 DOI: 10.1371/journal.pone.0186458] [Citation(s) in RCA: 289] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Methods Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives. Discussion The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.
Collapse
|
13
|
Mak WWS, Mo PKH, Ma GYK, Lam MYY. Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Soc Sci Med 2017; 188:30-40. [PMID: 28704645 DOI: 10.1016/j.socscimed.2017.06.045] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 06/17/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study conducted a meta-analysis and systematic review on studies evaluating the effectiveness of stigma reduction programs in improving knowledge and reducing negative attitudes towards people living with HIV (PLHIV). RESULTS Meta-analysis (k = 42 studies) found significant and small effect sizes in the improvement of the participants' knowledge of HIV/AIDS from interventions with (Cohen's d = 0.48, 95% CI [0.30, 0.66]) and without control groups (Cohen's d = 0.42, 95% CI [0.28, 0.57]). Significant and small effect sizes were found in the improvement of the participants' attitudes toward PLHIV from interventions with (Cohen's d = 0.39, 95% CI [0.23, 0.55]) and without control groups (Cohen's d = 0.25, 95% CI [0.11, 0.39]). Significant and small effect sizes were sustained at the follow-up assessments. Subgroup analysis showed that number of intervention sessions, intervention settings, and sample type significantly moderated the effect sizes in the meta-analysis. Findings from the systematic review of 35 studies indicated that most of the included studies showed positive results in reducing negative attitudes toward PLHIV and improving HIV-related knowledge. Most of the included studies tended to have low methodological quality. CONCLUSION The present meta-analysis and systematic review indicated that the studies generally found small improvement in HIV-related knowledge and reduction in negative attitudes towards PLHIV among the stigma reduction programs being evaluated. High-quality stigma reduction programs with multidimensional stigma indicators and psychometrically sound outcome measures are highly warranted.
Collapse
Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Gloria Y K Ma
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Maggie Y Y Lam
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| |
Collapse
|
14
|
Laar AK, Kwara A, Nortey PA, Ankomah AK, Okyerefo MPK, Lartey MY. Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy. Front Public Health 2017; 5:115. [PMID: 28603710 PMCID: PMC5445137 DOI: 10.3389/fpubh.2017.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. Methods A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Results One out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs)—46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83–33.72]. Those from a district level mission hospital (St. Martin’s ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074–9.120). Conclusion The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics.
Collapse
Affiliation(s)
- Amos K Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Priscillia A Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Augustine K Ankomah
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Margaret Y Lartey
- Department of Medicine, University of Ghana School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| |
Collapse
|
15
|
Mo PKH, Ng CTY. Stigmatization among people living with HIV in Hong Kong: A qualitative study. Health Expect 2017; 20:943-951. [PMID: 28195685 PMCID: PMC5600241 DOI: 10.1111/hex.12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
Background HIV/AIDS is one of the most stigmatized medical conditions across the world. Self‐stigma is prevalent among people living with HIV (PLHIV) and a major obstacle to HIV prevention and care. Objective This study aimed to describe the experiences of stigmatization and explore the possible factors that might be associated with stigmatization among PLHIV in Hong Kong. Design Qualitative in‐depth interviews were conducted. Setting and participants 15 PLHIV were recruited from two local non‐governmental organizations on HIV prevention. Main variables studied Participants were interviewed about their views and feelings towards oneself as a PLHIV and contributing factors, experiences of discriminations, stigmatizing behaviours, issues about disclosure, social relationships and potential impact of HIV. Results and conclusions Thematic analyses revealed three levels of factors which might be associated with stigmatization: (i) intrapersonal level (misconceptions about HIV, attribution of self‐responsibility, severe state of illness, side‐effects of medication), (ii) interpersonal level (discrimination, social rejection) and (iii) social level (mass media, public stereotypes). Findings provide important insights into which interventions to reduce stigmatization of PLHIV could be designed.
Collapse
Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Charlson T Y Ng
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
16
|
Mao Y, Li X, Qiao S, Zhou Y, Zhao Q. Ethnicity, Stigma and Adherence to Antiretroviral Therapy (ART) among People Living with HIV/AIDS in Guangxi, China. JOURNAL OF AIDS & CLINICAL RESEARCH 2017; 8:652. [PMID: 30140549 PMCID: PMC6103220 DOI: 10.4172/2155-6113.1000652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examines the impact of ethnicity and multiple types of HIV-related stigma on adherence to antiretroviral therapy (ART) among 2,146 people living with HIV/AIDS (PLWHA) in Guangxi, China who had initiated ART. The results of multiple binary logistic regressions indicate that those who had experienced enacted stigma tended to report lower adherence, while better adherence was associated with older age, being women and having a job. Ethnicity had a moderator effect on the association between internalized stigma and adherence since better adherence was associated with lower internalized stigma among participants in ethnic minority groups other than Zhuang. Our findings indicate that PLWHA of other ethnic minority groups could benefit from internalized stigma reduction interventions; PLWHA, overall, could benefit most from increased employment opportunities and acquisition of coping skills to mitigate the negative effects of enacted stigma.
Collapse
Affiliation(s)
- Yuchen Mao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Yuejiao Zhou
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Qun Zhao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| |
Collapse
|
17
|
Náfrádi L, Galimberti E, Nakamoto K, Schulz PJ. Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role of Health Literacy, Empowerment and Medication Beliefs. J Public Health Res 2016; 5:762. [PMID: 28083523 PMCID: PMC5206775 DOI: 10.4081/jphr.2016.762] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background Medication non-adherence is a major public health issue, creating obstacles to effective treatment of hypertension. Examining the underlying factors of deliberate and non-deliberate non-adherence is crucial to address this problem. Thus, the goal of the present study is to assess the socio-demographic, clinical and psychological determinants of intentional and unintentional non-adherence. Design and methods A cross-sectional survey was conducted between March, 2015 and April, 2016. The sample consisted of hypertension patients holding at least one medical prescription (N=109). Measurements assessed patients’ medication adherence, health literacy, empowerment, self-efficacy, medication beliefs, and patients’ acceptance of their doctor’s advice, socio-demographic and clinical characteristics. Results Patients who occasionally engaged in either intentional or unintentional non-adherence reported to have lower adherence selfefficacy, higher medication concern beliefs, lower meaningfulness scores and were less likely to accept the doctor’s treatment recommendations. Patients who occasionally engaged in unintentional nonadherence were younger and had experienced more side effects compared to completely adherent patients. Adherence self-efficacy was a mediator of the effect of health literacy on patients’ medication adherence and acceptance of the doctor’s advice was a covariate. Conclusions Regarding the research implications, health literacy and adherence self-efficacy should be assessed simultaneously when investigating the factors of non-adherence. Regarding the practical implications, adherence could be increased if physicians i) doublecheck whether their patients accept the treatment advice given and ii) if they address patients’ concerns about medications. These steps could be especially important for patients characterized with lower self-efficacy, as they are more likely to engage in occasional nonadherence. Significance for public health Medication non-adherence is a critical public health issue, leading to increased health care costs, morbidity and mortality across several chronic conditions. Medication non-adherence is also one of the main obstacles to effective hypertension care, as between 20-50% of the patients do not follow appropriately their prescribed medication regimen. Despite the large body of empirical evidence available, relatively little is known about the potential differences between the determinants underpinning intentional versus unintentional nonadherence. Shedding light on the factors of medication non-adherence is inevitable to develop interventions and health campaigns addressing the issue. Thus, the present study quantitatively examines the patient-related factors of medication non-adherence to antihypertensive drugs, distinguishing between the determinants of deliberate versus non-deliberate non-adherence. Moreover, based on the outcomes, we advocate potential new approaches to address medication non-adherence in hypertension.
Collapse
Affiliation(s)
- Lilla Náfrádi
- Institute of Communication and Health, Università della Svizzera italiana , Lugano, Switzerland
| | - Elisa Galimberti
- Institute of Communication and Health, Università della Svizzera italiana , Lugano, Switzerland
| | - Kent Nakamoto
- Institute of Communication and Health, Università della Svizzera italiana , Lugano, Switzerland
| | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana , Lugano, Switzerland
| |
Collapse
|
18
|
Chong ESK, Mak WWS, Tam TCY, Zhu C, Chung RWY. Impact of perceived HIV stigma within men who have sex with men community on mental health of seropositive MSM. AIDS Care 2016; 29:118-124. [PMID: 27350139 DOI: 10.1080/09540121.2016.1201190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Emerging evidence has suggested that seropositive men who have sex with men (MSM) do not only face biased treatment from the general public but also from members of the MSM community. We conceptualized such biases perpetuated within the MSM community as human immunodeficiency virus (HIV) in-group stigma. This study examined the pathways by which perceived HIV in-group stigma impacted the mental health of seropositive MSM in Hong Kong. Internalized HIV stigma, serostatus disclosure concerns, and negative reactions towards HIV stigma were hypothesized as intermediate factors. Based on 100 Chinese seropositive MSM who were on antiretroviral therapy, results of a path analysis partially supported our hypotheses. Only negative reactions towards HIV stigma within the MSM community was a significant intermediate factor. The findings highlight the importance of understanding seropositive MSM's different reactions to HIV stigma perpetuated within the MSM community. On top of stigma reduction research, further research may explore ways that help seropositive MSM cope with HIV in-group stigma and foster resilience.
Collapse
Affiliation(s)
- Eddie S K Chong
- a The Chinese University of Hong Kong , Shatin , NT , Hong Kong
| | - Winnie W S Mak
- a The Chinese University of Hong Kong , Shatin , NT , Hong Kong
| | - Terence C Y Tam
- a The Chinese University of Hong Kong , Shatin , NT , Hong Kong
| | - Chen Zhu
- a The Chinese University of Hong Kong , Shatin , NT , Hong Kong
| | | |
Collapse
|
19
|
Yang X, Mak WWS, Ho CYY, Chidgey A. Self-in-love versus self-in-stigma: implications of relationship quality and love attitudes on self-stigma and mental health among HIV-positive men having sex with men. AIDS Care 2016; 29:132-136. [PMID: 27345895 DOI: 10.1080/09540121.2016.1200714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study examines the mediating effect of love attitude on the associations between relationship quality with self-stigma and mental health among HIV-positive men having sex with men (MSM). Participants included 211 HIV-positive MSM (Mage = 41.77 years, SD = 11.10) and they were assessed on their relationship quality, love attitudes, HIV-positive self-stigma, and mental health. Structural equation modeling showed that the model fit the data well, χ2(50) = 152.80, p < .05, comparative fit index = .94, non-normed fit index = .92, standardized root mean square residual = .08. The indirect effect of perceived relationship quality on self-stigma was significant through love attitude. The indirect effect of love attitude on mental health was significant through reduced self-stigma. The outcomes differed by the number of partners, partner's knowledge of HIV-positive status, relationship nature, and marital status. Implications for developing a positive self-in-love to diminish self-stigma were discussed.
Collapse
Affiliation(s)
- Xue Yang
- a Department of Psychology , The Chinese University of Hong Kong , Hong Kong , People's Republic of China
| | - Winnie W S Mak
- a Department of Psychology , The Chinese University of Hong Kong , Hong Kong , People's Republic of China
| | - Connie Y Y Ho
- a Department of Psychology , The Chinese University of Hong Kong , Hong Kong , People's Republic of China
| | | |
Collapse
|
20
|
Laba TL, Essue B, Kimman M, Jan S. Understanding Patient Preferences in Medication Nonadherence: A Review of Stated Preference Data. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:385-95. [PMID: 25404203 DOI: 10.1007/s40271-014-0099-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nonadherence is a global problem undermining the cost-effectiveness of evidence-based medications. Aligning treatment choices with patient preferences may promote adherent behaviour: eliciting patient treatment preferences may help resolve the problem of nonadherence. As there is no reliable measure of nonadherent behaviour that can be used to derive preferences, stated-preference techniques offer a robust alternative. To understand patient preferences in medication nonadherence, we systematically appraised full-text English studies (from database inception to 24 February 2014) involving participants evaluating hypothetical scenarios to elicit preferences as an explicit means to understand medication nonadherence. Study characteristics (e.g. setting, disease, stated-preference method), attribute type and influence on choice were extracted. Seventeen full-text articles (4,456 patients) were included in the review, which reports stated-preference elicitation studies across a wide range of chronic and acute conditions. All studies were conducted in high-income settings. The influence of drug-related factors was predominant in patients' preferences for treatment. Patients preferred efficacious over safe medications except when considering the duration of therapy, but dosing and cost appeared more important when contemplating adherence. Patient characteristics, particularly medication experience, significantly influenced preferences. A disparity between stated preferences for treatment and adherence was reported. When using stated-preference techniques to understand nonadherence, this manuscript highlights that there is much room for methodological development. Studies outside of high-income settings are needed, particularly in relation to chronic diseases, for which nonadherence poses a substantial economic burden to health systems and patients. To inform the problem of sustaining adherence, prospective research is needed to understand how preferences change with time. The usefulness of stated-preference techniques to inform policy and practice requires a better understanding of how stated preferences relate to actual adherence behaviour.
Collapse
Affiliation(s)
- Tracey-Lea Laba
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia. .,The Faculty of Pharmacy, University of Sydney, Camperdown, NSW, 2010, Australia.
| | - Beverley Essue
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia.,The Menzies Centre for Health Policy, University of Sydney, Camperdown, NSW, 2010, Australia
| | - Merel Kimman
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of Sydney, Camperdown, NSW, 2010, Australia.,The Menzies Centre for Health Policy, University of Sydney, Camperdown, NSW, 2010, Australia
| |
Collapse
|
21
|
Shin S, Muñoz M, Caldas A, Ying Wu, Zeladita J, Wong M, Espiritu B, Sanchez E, Callacna M, Rojas C, Arevalo J, Sebastian JL, Bayona J. Mental Health Burden Among Impoverished HIV-Positive Patients in Peru. ACTA ACUST UNITED AC 2016; 10:18-25. [PMID: 21368011 DOI: 10.1177/1545109710385120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.
Collapse
Affiliation(s)
- Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Socios En Salud Sucursal Perú, Lima, Peru, Harvard Medical School, Boston, MA, USA, Division of Infectious Diseases, Brigham and Women's Hospital, Boston MA, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Yu ZL, Lee VYW, Kang AWC, Chan S, Foo M, Chan CM, Griva K. Rates of Intentional and Unintentional Nonadherence to Peritoneal Dialysis Regimes and Associated Factors. PLoS One 2016; 11:e0149784. [PMID: 26919323 PMCID: PMC4769138 DOI: 10.1371/journal.pone.0149784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/04/2016] [Indexed: 11/20/2022] Open
Abstract
With increasing emphasis on expanding home-based dialysis, there is a need to understand adherence outcomes. This study set out to examine the prevalence and predictors of nonadherence among patients undergoing peritoneal dialysis. A cross sectional sample of 201 peritoneal dialysis patients recruited between 2010–2011 from Singapore General Hospital completed measures of quality of life, medication beliefs, self-efficacy and emotional distress. Nonadherence rates were high; 18% for dialysis, 46% for medication and 78% for diet. Intentional nonadherence was more common for dialysis (p = .03), whereas unintentional nonadherence was more common for medication (p = .002). Multivariate models indicated significant associations for higher education (intermediate vs low OR = 3.18, high vs low OR = 4.70), lower environment quality of life (OR = 0.79), dialysis self-efficacy (OR = 0.80) with dialysis nonadherence; higher education (OR = 2.22), self-care peritoneal dialysis (OR = 3.10), perceived necessity vs concerns over medication (OR = 0.90), self-efficacy (OR = 0.76) with nonadherence to medication. The odds for nonadherence to diet were higher among patients who were younger (OR = 0.96), of Chinese ethnicity (OR = 2.99) and those reporting better physical health (OR = 1.30) and lower self-efficacy (OR = 0.49). Nonadherence is common in peritoneal dialysis. Self-efficacy and beliefs about medication are promising targets for interventions designed to improve adherence.
Collapse
Affiliation(s)
- Zhen Li Yu
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Vanessa Yin Woan Lee
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | | | - Sally Chan
- Alice Lee Centre for Nursing Studies, National University Hospital, Singapore, Singapore
| | - Marjorie Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore, Singapore
- Health Services Research Group, City University London, London, United Kingdom
- * E-mail:
| |
Collapse
|
23
|
Sweeney SM, Vanable PA. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature. AIDS Behav 2016; 20:29-50. [PMID: 26303196 DOI: 10.1007/s10461-015-1164-1] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.
Collapse
Affiliation(s)
- Shannon M Sweeney
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
| |
Collapse
|
24
|
Mo PKH, Lau JTF, Yu X, Gu J. A model of associative stigma on depression and anxiety among children of HIV-infected parents in China. AIDS Behav 2015; 19:50-9. [PMID: 24879629 DOI: 10.1007/s10461-014-0809-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Human immunodeficiency virus (HIV) carries a high level of stigma to the HIV-infected individuals and their family members. Children of HIV-infected parents in China are particularly affected. The present study examined the relationship between associative stigma, self-esteem, optimism, anxiety and depression among 195 children of HIV-infected parents in rural China. Findings showed that more than one-third (35.4 %) of the participants scored higher than cut-off for depression; and 23.6-67.7 % of them scored higher than cut-off for different types of anxiety disorders. Structural equation modelling revealed that associative stigma had a significant negative relationship on self-esteem and optimism, which were associated with higher levels of depression and anxiety. The indirect effects of associative stigma on depression and anxiety were significant. The overall model showed a satisfactory fit. Findings suggest that associative stigma has a significant negative impact on mental health of children affected by HIV. Interventions to reduce their associative stigma are warranted.
Collapse
Affiliation(s)
- Phoenix K H Mo
- Center for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | | | | | | |
Collapse
|
25
|
Okonsky JG, Webel A, Rose CD, Johnson M, Asher A, Cuca Y, Kaihura A, Hanson JE, Portillo CJ. Appreciating Reasons for Nonadherence in Women. Health Care Women Int 2014; 36:1007-25. [PMID: 24654887 DOI: 10.1080/07399332.2014.903952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Women aged 15-24 years have an HIV infection rate twice that of men the same age. In this study we examined reasons why HIV-infected women taking antiretroviral therapy (ART) report missing HIV medications. Women (N = 206) on ART were 2.2 times more likely to endorse reasons pertaining to forgetfulness versus reasons pertaining to problems taking pills (OR = 2.2, 95% CI = 1.63, 2.94, p <.001). There was a difference between the adherent and nonadherent groups in types of reasons overall (p <.001, 95% CI = -3.82, -2.03). Using a patient-centered approach to understand type of nonadherence (intentional vs. unintentional) may support development of novel interventions.
Collapse
Affiliation(s)
- Jennifer G Okonsky
- a Department of Community Health Systems, School of Nursing , University of California San Francisco , San Francisco , California , USA
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Cornally N, Ann Deasy E, McCarthey G, McAuley C, Moran J, Weathers E, McAuley C. Student nurses' intention to get the influenza vaccine. ACTA ACUST UNITED AC 2014; 22:1207-11. [PMID: 24280920 DOI: 10.12968/bjon.2013.22.21.1207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION There is no national or international recommendation for nursing students to receive the influenza vaccine. Nurses are among the group of health professionals who traditionally have a low uptake of the vaccine and who arguably have the closest contact with patients. AIM To investigate the uptake of influenza vaccination among student nurses, explore reasons for either declining or receiving it in the past, and establish if and to what extent the theory of planned behaviour (TPB) can explain vaccination behaviour. METHODS A quantitative, descriptive, correlational design was used. Data were collected with a researcher-developed questionnaire; 131 student nurses participated. Ethical approval was gained. RESULTS 79% (n=104) had never received the vaccine. The most common reason was 'I don't need it as I rarely get ill'. Low mean 'intention' scores indicated that students were unlikely to get the vaccine once qualified. Past behaviour was significantly associated with future intentions. The TPB explained 41.9% of the variance in intention. Attitude emerged as the greatest predictor. CONCLUSION Student nurses do not have strong intentions to get the vaccine. Results serve to guide future educational and occupational health initiatives, which would benefit from a framework based on TPB.
Collapse
Affiliation(s)
- Nicola Cornally
- Research Support Officer, Clinical Research Nurse, Centre for Gerontology and Rehabilitation, School of Medicine
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc 2013; 16:18640. [PMID: 24242258 PMCID: PMC3833107 DOI: 10.7448/ias.16.3.18640] [Citation(s) in RCA: 727] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 08/22/2013] [Accepted: 08/29/2013] [Indexed: 01/20/2023] Open
Abstract
Introduction Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ART adherence. Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ART adherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support. We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical determinants of participants’ ability to overcome the structural and economic barriers associated with poverty in order to successfully adhere to ART. Among the 41 quantitative studies, 24 of 33 cross-sectional studies (71%) reported a positive finding between HIV stigma and ART non-adherence, while 6 of 7 longitudinal studies (86%) reported a null finding (Pearson's χ2=7.7; p=0.005). Conclusions We found that HIV-related stigma compromised participants’ abilities to successfully adhere to ART. Interventions to reduce stigma should target multiple levels of influence (intrapersonal, interpersonal and structural) in order to have maximum effectiveness on improving ART adherence.
Collapse
|
29
|
Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornman DH, Trayling CA, Redding C, Fisher JD. Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care. AIDS Care 2011; 22:979-87. [PMID: 20552469 DOI: 10.1080/09540121003758630] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since the arrival of antiretroviral (ARV) therapy, HIV has become better characterized as a chronic disease rather than a terminal illness, depending in part on one's ability to maintain relatively high levels of adherence. Despite research concerning barriers and facilitators of ARV adherence behavior, relatively little is known about specific challenges faced by HIV-positive persons who report "taking a break" from their ARV medications. The present study employed the Information-Motivation-Behavioral Skills Model of ARV adherence as a framework for understanding adherence-related barriers that may differentiate between non-adherent patients who report "taking a break" versus those who do not report "taking a break" from their ARV medications. A sample of 327 HIV-positive patients who reported less than 100% adherence at study baseline provided data for this research. Participants who reported "taking a break" from their HIV medications without first talking to their healthcare provider were classified as intentionally non-adherent, while those who did not report "taking a break" without first talking with their healthcare provider were classified as unintentionally non-adherent. Analyses examined differences between intentionally versus unintentionally non-adherent patients with respect to demographic characteristics and responses to the adherence-related information, motivation, and behavioral skills questionnaire items. Few differences were observed among the groups on demographics, adherence-related information, or adherence-related motivation; however, significant differences were observed on about half of the adherence-related behavioral skills items. Implications for future research, as well as the design of specific intervention components to reduce intentionally non-adherent behavior, are discussed.
Collapse
Affiliation(s)
- Wynne E Norton
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|