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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024; 36:1382-1391. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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Ashaba S, Baguma C, Tushemereirwe P, Nansera D, Maling S, Zanon BC, Tsai AC. Correlates of HIV treatment adherence self-efficacy among adolescents and young adults living with HIV in southwestern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003600. [PMID: 39231105 PMCID: PMC11373852 DOI: 10.1371/journal.pgph.0003600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
Adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa is sub-optimal compared to younger children and older adults. Adherence self-efficacy is one of the intrapersonal factors most strongly correlated with ART adherence. The role of adherence self-efficacy in ART adherence among AYLHIV is not well studied in Uganda. We enrolled 300 AYLHIV between October and December 2021 from an HIV clinic in southwestern Uganda. We collected information on adherence self-efficacy, HIV stigma, depression, self-management, and social skills. We used linear regression to estimate the association between adherence self-efficacy and the covariates of interest. At multivariable adjustment self-management (b = 0.29, 95% CI 0.23-0.35, p<0.001) and social skills (b = 0.16, 95% CI 0.08-0.24; p<0.001) were statistically significantly associated with adherence self-efficacy. The findings imply that interventions directed at enhancing self-management and social skills in AYLHIV may increase adherence self-efficacy and, potentially, HIV outcomes among AYLHIV.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles Baguma
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Denis Nansera
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian C Zanon
- Department of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Goergia, United States of America
- Department of Pediatric Infectious, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Alexander C Tsai
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Psychiatry, Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
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Acharya S, Parthasarathy MR, Karanjkar V, Katkar S, Setia MS. Barriers and facilitators for adherence to antiretroviral therapy, and strategies to address the barriers in key populations, Mumbai-A qualitative study. PLoS One 2024; 19:e0305390. [PMID: 38990894 PMCID: PMC11239046 DOI: 10.1371/journal.pone.0305390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Even though quantitative studies have described barriers to anti-retroviral therapy (ART), a more exploratory approach will provide in-depth information on these issues, and potential suggestions to address these issues at individual as well as structural level. We designed this qualitative study to examine the barriers and facilitators for antiretroviral therapy adherence in key population (KP) in Mumbai, India. We also wanted to understand the strategies adopted by these groups and get suggestions to improve adherence to ART. METHODS This is a qualitative analysis of seven focus group discussions (FGDs) conducted with four KP subgroups in Mumbai. We conducted two FGDs each with female sex workers (FSW), men who have sex with men (MSM), male-to-female transgendered people/Hijras (TGH) each, and one FGD with people who inject drugs (IDU). We transcribed the audio-recorded electronic records of these FGDs. We also added the notes of the observers on the group dynamics to the transcribed data. We used the Framework Approach to analyse these data. RESULTS Some experiences-such as side effects to ART medicines-were common across groups. However, incarceration as a reason for stopping ART was reported by FSWs but not by other KPs. Friends and family (including Guru) are important support systems for HIV infected individuals and adherence to ART. Stigma and discrimination by community members and general community prevent regular access of ART centres and other health care facilities. Additional factors which led to missed doses were mental health issues, alcohol use, and misplacing the ART tablets during police raids or during robbery attempts at the cruising sites. Since a common source of discrimination among peers and the community was the presence of 'Green book' (or their treatment book); the key population wanted the AIDS program to change it to digital cards so that labelling one as 'HIV positive' for being seen with the book can be avoided. CONCLUSIONS The qualitative study helped us explore the barriers to ART among key population and the community provided specific suggestions to address them. In addition to Key Population centric enhanced adherence counselling, some administrative guidelines and procedures may need to be altered to improve adherence to ART in these populations.
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Affiliation(s)
- Shrikala Acharya
- Mumbai Districts AIDS Control Society, Mumbai, India
- Seth GS Medical College and KEM Hospital, Mumbai, India
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Abdisa M, Gindaba BG, Zerihun E. Factors influencing self-efficacy for self-management among adult people with human immune deficiency virus on antiretroviral therapy in public hospitals of south-west Ethiopia. Front Psychol 2024; 15:1329238. [PMID: 38379624 PMCID: PMC10876861 DOI: 10.3389/fpsyg.2024.1329238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Self-management is crucial for effective HIV management, and self-efficacy is a mechanism for achieving it, but there is limited evidence on variables that affect self-efficacy. This study aimed to identify factors influencing self-efficacy for self-management among adults on antiretroviral therapy in resource constraint settings. Methods A cross-sectional study was conducted among 422 adult people on antiretroviral therapy in southwest Ethiopia from March to April 2022. Face-to-face interviews were used to gather data using a structured questionnaire on the self-efficacy measure. The data were then imported into Epi Data version 4.2 and exported to SPSS version 26. Descriptive statistics, independent tests, one-way analysis of variance, Pearson correlation, and multivariate linear regression were used to analyze the data. The predictors with p-value of less than 0.05 were declared statistically significant. Results A total of 413 adults on antiretroviral therapy were interviewed with response rate of 97.9%. The total mean score of self-efficacy for self-management was 15.12 (±2.22) out of 24. Higher age, gender of the female, divorced, duration of diagnosis, and drug side effects were negatively predictors of low self-efficacy. Higher schooling, urban residence, better income, and the use of reminders positively influenced self-efficacy for self-management. Conclusion The study found low self-efficacy among adults on antiretroviral therapy and higher age, female gender, HIV duration, and presence of drug side effects were associated with lower self-efficacy, while higher schooling, better income, and use of reminder use were associated with higher self-efficacy for self-management. Further research is needed to determine the causal relationship between these variables and self-efficacy.
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Affiliation(s)
| | - Bekan Gudeta Gindaba
- School of Nursing and Midwifery, Institute of Health Science, Wallaga University, Nekemte, Ethiopia
| | - Ebisa Zerihun
- Department of Nursing, College of Health Science, Oda Bultum University, Chiro, Ethiopia
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Niarchou E, Roberts LH, Naughton BD. What is the impact of antidepressant side effects on medication adherence among adult patients diagnosed with depressive disorder: A systematic review. J Psychopharmacol 2024; 38:127-136. [PMID: 38344912 PMCID: PMC10863360 DOI: 10.1177/02698811231224171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Medication adherence is a prerequisite to achieving beneficial treatment outcomes. In major depressive disorder, many patients fail to complete medication regimens, raising concern for poor treatment outcomes. It is usual to experience adverse drug reactions (ADRs) while taking antidepressants, and relative discomfort is reported by patients. AIMS The present review focuses on the presence of antidepressant-related side effects and the subsequent relationship with medication non-adherence. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Following the preliminary research, the research question and eligibility criteria were created based on the PICO framework. All articles retrieved from the selected databases were exported to Covidence, a Systematic Review managing software tool. Two reviewers assessed the papers to identify the risk of bias using the Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Seven studies with a low-moderate risk of bias fulfilled the eligibility criteria and were conducted from 2013 to 2020 in Europe, Africa and Asia. RESULTS The results demonstrated high levels of suboptimal adherence ranging from 46% to 83% amongst the studied population. A variety of side effects were reported by a significant number of participants predominantly with moderate severity. A correlation between the presence of ADRs and suboptimal rates of adherence to antidepressants was found. Somnolence and headaches among other unspecified ADRs were found to increase the dropout rates for selective serotonin reuptake inhibitors. CONCLUSIONS The present study elucidates the need for effective interventions to facilitate antidepressant adherence and enhance doctor-patient communication, benefiting both the individuals and the healthcare system and leading to better clinical outcomes and reduction of relapse-related costs.
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Affiliation(s)
- Eleni Niarchou
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - LH Roberts
- Department of Psychology, University of Buckingham, Buckingham, UK
| | - Bernard D. Naughton
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Ezenwosu IL, Onu JU, Chukwuma UV, Onwuka-Kalu C, Omotola OF, Ezenwosu OU, Chukwuka CJ. Effect of dolutegravir-based drug combinations on the level of medication adherence and viral load among adolescents living with HIV in resource-limited setting: a pre-post design. Int J Adolesc Med Health 2023; 35:457-465. [PMID: 38059505 DOI: 10.1515/ijamh-2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES The use of antiretroviral drugs among HIV-infected adolescents has been challenged with poor medication adherence, leading to an unsuppressed viral load and ultimately to drug resistance. Recently, dolutegravir has been approved for use in adolescents with HIV, but the evidence on medication adherence and viral load suppression is limited. The study determined the effect of dolutegravir-based drug regimens on the level of medication adherence and viral load among treatment-experienced adolescents. METHODS A longitudinal pre-post design study was done among adolescents living with HIV at a paediatrics clinic in Nigeria. Assessment of medication adherence and viral load testing was done before and at six months of transitioning to dolutegravir-based regimens. McNemar-chi-square was used to determine the effectiveness of the drug on adherence and viral load suppression. Multivariate logistic regression analysis was performed to determine the predictors of drug adherence and viral suppression. RESULTS The mean age of the participants was 14.7 years (SD=3.2), and 53.3 % were males. The mean duration of ART use was 10.3 years (SD=3.2). Six months after transitioning to dolutegravir, there was a significant decrease in viral load (Z=-7.947, p<0.001) and an increase in medication adherence score (Z=-7.554, p<0.001), among the treatment-experienced adolescents. Viral suppression was 13 times higher among respondents with good medication adherence as compared to those with poor medication adherence (AOR=13.24, CI=3.25-53.90). CONCLUSIONS Dolutegravir is effective in improving medication adherence and viral suppression among Adolescents living with HIV. Thus, the need to transition eligible adolescents to dolutegravir to sustain better treatment outcomes.
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Affiliation(s)
- Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Justus U Onu
- Department of Mental Health, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Uchenna V Chukwuma
- Department of Family Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Chima Onwuka-Kalu
- Department of Hematology and Immunology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Olusegun F Omotola
- Department of Pharmacy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Osita U Ezenwosu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Chinwe J Chukwuka
- Department of Internal Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
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Tao Y, Xiao X, Ma J, Wang H. The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy. Front Psychol 2022; 13:1094575. [PMID: 36600713 PMCID: PMC9807034 DOI: 10.3389/fpsyg.2022.1094575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson's bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.
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Areri HA, Marshall A, Harvey G. Self-efficacy for self-management and its influencing factors among adults living with HIV on antiretroviral therapy in northwest Ethiopia. AIDS Care 2022; 34:1595-1601. [PMID: 34851784 DOI: 10.1080/09540121.2021.2007839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Previous research has identified that self-efficacy is an essential factor in the process of self-management; however, the evidence is lacking concerning factors influencing self-efficacy in low-income countries. Therefore, this study examined factors influencing self-efficacy. A validated survey tool was orally administered to 415 adults living with HIV. Many of the respondents, 82.4%, do not have a regular job while one-fourth (25.5%) of the respondents were from a rural area. A mean self-efficacy score, 19.76 ± 0.12 out of a maximum of 24 was identified. This self-efficacy score was positively correlated with age, educational level, income and job status, but negatively correlated with gender, residency and drug side effects. Income, residency in rural, and experiencing drug side effects were significant predictors of self-efficacy and explained 5.4% of the variance. Better income (β = 0.514, p = 0.029) was associated with a higher self-efficacy score but living in rural areas (β = -0.520, p = 0.043) and experiencing drug side effects (β = -1.246, p = 0.001) were associated with a lower self-efficacy score. The use of Individual and Family Self-Management Theory helps clinician and patients to work together to identify factors influencing self-efficacy and to intervene.
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Affiliation(s)
- Habtamu Abera Areri
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Hossain F, Hasan M, Begum N, Mohan D, Verghis S, Jahan NK. Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh: A qualitative approach. PLoS One 2022; 17:e0276575. [PMID: 36269716 PMCID: PMC9586390 DOI: 10.1371/journal.pone.0276575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. METHODS We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. RESULTS The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. CONCLUSIONS We recommended strengthening Bangladesh's HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
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Affiliation(s)
- Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | | | | | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Sharuna Verghis
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
- * E-mail:
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Chen WT, Shiu C, Zhang L, Zhao H. Care engagement with healthcare providers and symptom management self-efficacy in women living with HIV in China: secondary analysis of an intervention study. BMC Public Health 2022; 22:1195. [PMID: 35705934 PMCID: PMC9199138 DOI: 10.1186/s12889-022-13573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Symptom management self-efficacy is a prerequisite for individuals to fully manage their symptoms. The literature reports associations between engagement with healthcare providers (HCPs), internalized stigma, and types of self-efficacy other than symptom management. However, the factors of symptom management self-efficacy are not well understood. This study aimed to investigate the relationship among engagement with HCPs, internalized stigma, and HIV symptom management self-efficacy in Chinese women living with HIV (WLWH). Methods This current analysis was part of the original randomized control trial, we used data collected from 41 women living with HIV (WLWH) assigned to an intervention arm or a control arm from Shanghai and Beijing, China, at baseline, Week 4 and Week 12. The CONSORT checklist was used. The study was registered in the Clinical Trial Registry (#NCT03049332) on 10/02/2017. Results The results demonstrate that HCPs should increase engagement with WLWH when providing care, thereby improving their symptom management self-efficacy. The results suggested that participants’ engagement with HCPs was significantly positively correlated with their HIV symptom management self-efficacy in the latter two time points. Internalized stigma was significantly negatively correlated with HIV symptom management self-efficacy only at the 4-week follow-up. Conclusions This study demonstrated the positive effect of engagement with HCPs on WLWHs’ symptom management self-efficacy as well as the negative effect of internalized stigma on symptom management self-efficacy. Future research can further test the relationship between the three key concepts, as well as explore interventions to decrease internalized stigma.
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Affiliation(s)
- Wei-Ti Chen
- School of Nursing, University of California Los Angeles, 700 Tiverton Ave, Los Angeles, CA, 90095, USA.
| | - Chengshi Shiu
- School of Nursing, University of California Los Angeles, 700 Tiverton Ave, Los Angeles, CA, 90095, USA.,National Taiwan University, Taipei, Taiwan
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
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Addo MK, Aboagye RG, Tarkang EE. Factors influencing adherence to antiretroviral therapy among HIV/AIDS patients in the Ga West Municipality, Ghana. IJID REGIONS 2022; 3:218-225. [PMID: 35755462 PMCID: PMC9216268 DOI: 10.1016/j.ijregi.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Antiretroviral therapy (ART) is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing ART adherence among HIV-positive clients in the Ga West Municipality, Ghana using the Health Belief Model (HBM). METHODS A facility-based cross-sectional design was adopted among 397 HIV clients aged 18 years and above. Data were collected using an interviewer-administered questionnaire and analysed using Stata version 16.0. Binary logistic regression was performed at the P < 0.05 level. RESULTS Adherence to ART was 44.6%. Clients who took less than 30 minutes to reach ART sites were 59% less likely to adhere to ART (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.82). Clients who thought they lost income when they went to obtain their ART refill were more likely to adhere to ART (OR 1.71, 95% CI 1.04-2.83), as were those who developed side effects (OR 1.74, 95% CI 1.05-2.89) (perceived barriers). Clients who had confidence in their ability to take their medications (self-efficacy) (OR 1.86, 95% CI 1.05-3.31) and those who received reminders from health workers (cues to action) (OR 1.91, 95% CI 1.04-3.53) were more likely to adhere to ART. CONCLUSIONS Interventions should focus on increasing client confidence in adhering to ART. Providers should be empowered to provide reminders to patients.
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Affiliation(s)
- Mavis Kessewa Addo
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Richard Gyan Aboagye
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Elvis Enowbeyang Tarkang
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
- HIV/AIDS Prevention Research Network Cameroon PO Box 36 Kumba Southwest Region, Cameroon
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Nyamaruze P, Govender K, Cowden RG. Self-esteem and antiretroviral therapy adherence among young people living with HIV: An exploratory serial mediation analysis. S AFR J SCI 2021. [DOI: 10.17159/sajs.2021/8354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Capitalising further on the benefits of antiretroviral therapy (ART) for individual treatment requires an improved understanding of the psychological processes that may affect optimal ART adherence among people living with HIV. We examined internalised HIV/AIDS-related stigma and body appreciation as mediators of the association between self-esteem and ART adherence among young people living with HIV (YPLHIV). A sample of 76 YPLHIV (Mage = 19.36, s.d.age = 2.56; male 56.58%) residing in an HIV hyperendemic region of South Africa completed self-report measures of self-esteem, internalised HIV/AIDS-related stigma, body appreciation, and ART adherence. Path-analytic mediation modelling was performed to test for direct and indirect effects linking self-esteem with ART adherence. Results of serial mediation analyses indicated that self-esteem and ART adherence were indirectly associated through a two-step path of internalised HIV/AIDS-related stigma and then body appreciation, as well as a one-step path through internalised HIV/AIDS-related stigma. The results provide preliminary support for internalised HIV/AIDS-related stigma and body appreciation as mechanisms underlying the association between self-esteem and ART adherence. Implications of the findings for promoting ART adherence among YPLHIV are discussed.
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Affiliation(s)
- Patrick Nyamaruze
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Richard G. Cowden
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
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Twimukye A, Laker M, Odongpiny EAL, Ajok F, Onen H, Kalule I, Kajubi P, Seden K, Owarwo N, Kiragga A, Armstrong-Hough M, Katahoire A, Mujugira A, Lamorde M, Castelnuovo B. Patient experiences of switching from Efavirenz- to Dolutegravir-based antiretroviral therapy: a qualitative study in Uganda. BMC Infect Dis 2021; 21:1154. [PMID: 34774018 PMCID: PMC8590364 DOI: 10.1186/s12879-021-06851-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background In 2019, the World Health Organisation (WHO) recommended Dolutegravir (DTG) as the preferred first-line antiretroviral treatment (ART) for all persons with HIV. ART regimen switches may affect HIV treatment adherence. We sought to describe patient experiences switching from EFV to DTG-based ART in Kampala, Uganda. Methods Between July and September 2019, we purposively sampled adults living with HIV who had switched to DTG at the Infectious Diseases Institute HIV clinic. We conducted in-depth interviews with adults who switched to DTG, to explore their preparation to switch and experiences on DTG. Interviews were audio-recorded, transcribed and analysed thematically using Atlas ti version 8 software. Results We interviewed 25 adults: 18 (72%) were women, and the median age was 35 years (interquartile range [IQR] 30–40). Median length on ART before switching to DTG was 67 months (IQR 51–125). Duration on DTG after switching was 16 months (IQR 10–18). Participants reported accepting provider recommendations to switch to DTG mainly because they anticipated that swallowing a smaller pill once a day would be more convenient. While most participants initially felt uncertain about drug switching, their providers offer of frequent appointments and a toll-free number to call in the event of side effects allayed their anxiety. At the same time, participants said they felt rushed to switch to the new ART regimen considering that they had been on their previous regimen(s) for several years and the switch to DTG happened during a routine visit when they had expected their regular prescription. Some participants felt unprepared for new adverse events associated with DTG and for the abrupt change in treatment schedule. Most participants said they needed additional support from their health providers before and after switching to DTG. Conclusion and recommendations Adults living with HIV stable on an EFV-based regimen but were switched to DTG in a program-wide policy change found the duration between counselling and drug switching inadequate. DTG was nonetheless largely preferred because of the small pill size, once daily dosing, and absence of EFV-like side effects. Community-engaged research is needed to devise acceptable ways to prepare participants for switching ART at scale. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06851-9.
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Affiliation(s)
- Adelline Twimukye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda.
| | - Miriam Laker
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Eva Agnes Laker Odongpiny
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | | | - Henry Onen
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Ivan Kalule
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Phoebe Kajubi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Kay Seden
- University of Liverpool, Liverpool, UK
| | - Noela Owarwo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, USA.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Anne Katahoire
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda.,School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
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14
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Li C, Giovenco D, Dong W, Smith MK, Golin CE, Fisher EB, Lei G, Jiang H, Tang PY, Muessig KE. Understanding How Gay, Bisexual, and Other Men Who Have Sex With Men in China Cope With HIV Care-Related Stressors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:46-61. [PMID: 33617323 PMCID: PMC10552686 DOI: 10.1521/aeap.2021.33.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Understanding how Chinese gay, bisexual, and other men who have sex with men (GBMSM) cope with HIV care-related stressors could improve their care engagement. Qualitative semistructured interviews were conducted with 30 GBMSM living with HIV recruited through clinics and a community-based organization (CBO) in Chengdu, China. Interviews focused on treatment-related stress, coping strategies, social support, and well-being. Half reported symptoms consistent with mild or moderate depression as measured by the PHQ-9 scale. HIV care-related stressors included side effects, difficulty with adherence, and fear of drug resistance. Challenges to coping include navigating contradictory information about HIV and treatment, experiencing stigma and discrimination within medical and nonmedical settings, and managing financial concerns. CBOs, peer groups, and providers were salient sources of social support benefitting coping. To improve sustained HIV care that meets the needs of Chinese GBMSM living with HIV, tailored interventions that address the above-mentioned stressors and coping challenges are likely needed.
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Affiliation(s)
- Chunyan Li
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Danielle Giovenco
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Willa Dong
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Kumi Smith
- University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Carol E Golin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edwin B Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gang Lei
- Aibai Culture and Education Center, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine and Sichuan Provincial People's Hospital and Sichuan Academy of Medical Sciences, Chengdu, China
| | - Patrick Y Tang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn E Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Zeng C, Li X, Qiao S, Yang X, Shen Z, Zhou Y. Anticipated stigma and medication adherence among people living with HIV: the mechanistic roles of medication support and ART self-efficacy. AIDS Care 2020; 32:1014-1022. [PMID: 32336130 DOI: 10.1080/09540121.2020.1728213] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to examine the relationship between anticipated stigma and medication adherence as well as the mechanistic roles of medication support and ART self-efficacy. Data were derived from the baseline assessment of a prospective cohort study in Guangxi, China. A total of 1198 PLWH were recruited and assessed on their sociodemographic characteristics, medication adherence, anticipated stigma, medication support, and ART self-efficacy. Path analysis was used to examine the direct effect from anticipated stigma to medication adherence and indirect effects through medication support and ART self-efficacy. Path model revealed that the indirect effect from anticipated stigma to medication adherence was statistically significant while the direct effect was not significant. Anticipated stigma could influence medication adherence through ART self-efficacy but not through medication support. The serial mediating effect of medication support and ART self-efficacy on the relationship between anticipated stigma and medication adherence was significant. Anticipated stigma affects medication adherence among PLWH through its adverse impact on medication support and ART self-efficacy. Tailored interventions promoting medication support and ART self-efficacy may alleviate the negative influence of anticipated stigma on medication adherence among PLWH. Additionally, policy efforts aiming to reduce stigma against PLWH and increasing medication support are warranted to improve medication adherence among PLWH.
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Affiliation(s)
- Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
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16
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HIV Disclosure to Family Members and Medication Adherence: Role of Social Support and Self-efficacy. AIDS Behav 2020; 24:45-54. [PMID: 30863978 DOI: 10.1007/s10461-019-02456-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although antiretroviral therapy (ART) is vital to people living with HIV (PLWH) by suppressing the virus and in turn preventing onward HIV transmission and reducing AIDS-related morbidity and mortality, the rates of optimal ART adherence continuously remain low. Disclosure of HIV status is considered to be a critical predictor of ART adherence. However, few studies have explored the mechanisms underlying the association between disclosure and medication adherence. The current study aims to examine the mediating role of social support and self-efficacy underlying the relationship between HIV disclosure to family members and ART adherence. PLWH in China provided data on HIV disclosure, ART adherence, perceived social support on medication adherence, adherence self-efficacy, and social-demographic information. The path analyses revealed that disclosure to family members had significant indirect effects on adherence via social support and self-efficacy. Our findings suggested that HIV disclosure might positively affect ART adherence through two psychosocial pathways: social support and self-efficacy. Future intervention to improve medication adherence among PLWH should consider targeting these two factors.
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17
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Jiang Y, Li X, Cho H, Brown MJ, Qiao S, Haider MR. Effects of individual and neighborhood socioeconomic status on antiretroviral therapy adherence: The role of adherence self-efficacy. J Health Psychol 2019; 26:1143-1153. [PMID: 31419916 DOI: 10.1177/1359105319869809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the potential mediation effect of adherence self-efficacy on the associations between individual and neighborhood socioeconomic status and antiretroviral therapy adherence in a sample of 337 people living with HIV in South Carolina, United States. Results showed that there were no direct effects of individual or neighborhood socioeconomic status on antiretroviral therapy adherence, whereas both individual socioeconomic status and neighborhood socioeconomic status were associated with adherence self-efficacy, which in turn were related to antiretroviral therapy adherence. These findings suggest that interventions targeting adherence self-efficacy may improve antiretroviral therapy adherence among people living with HIV with low socioeconomic status or those living in socioeconomically disadvantaged neighborhoods.
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18
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Wesevich A, Hosseinipour MC, Golin CE, McGrath N, Tsidya M, Chimndozi L, Bhushan N, Hoffman I, Miller WC, Rosenberg NE. Female adherence self-efficacy before and after couple HIV testing and counseling within Malawi's Option B+ program. AIDS Care 2019; 32:170-174. [PMID: 31238717 DOI: 10.1080/09540121.2019.1634789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adherence self-efficacy, belief in one's ability to adhere to daily medication, is strongly associated with antiretroviral therapy (ART) adherence and preventing mother-to-child HIV transmission. Couple-based interventions could enhance self-efficacy and adherence. We assessed the relationship between couple HIV testing and counseling (cHTC) and adherence self-efficacy using a 100-point culturally-adapted adherence self-efficacy scale (ASES). Secondarily, we explored the relationship between ASES and ART adherence. Ninety HIV-positive pregnant women at an antenatal clinic in Lilongwe, Malawi were enrolled in an observational cohort study. They were assessed with ASES immediately before and one month after receiving cHTC. Median ASES scores were 100 (IQR 95, 100) before and 100 (IQR 99, 100) after cHTC; there was a significant median difference (p = 0.02) for participants before and after cHTC. This change in ASES scores was associated with the odds of self-reported ART adherence in the full population (OR 1.1, p = 0.01), and there was a trend in the same direction for participants with imperfect baseline ASES scores (OR 1.1, p = 0.2). In our population, adherence self-efficacy and ART adherence were both quite high, and those who had room to improve in self-efficacy may have benefited from cHTC, which in turn could impact ART adherence and ultimately mother-to-child transmission.
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Affiliation(s)
- Austin Wesevich
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Mina C Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Carol E Golin
- Departments of Medicine and of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nuala McGrath
- Departments of Primary Care and Population Sciences and of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Mercy Tsidya
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Limbikani Chimndozi
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi
| | - Nivedita Bhushan
- University of North Carolina Project, Lilongwe, Malawi.,Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Irving Hoffman
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - William C Miller
- Division of Epidemiology, The Ohio State University, Columbus, USA
| | - Nora E Rosenberg
- University of North Carolina Project, Lilongwe, Malawi.,Tidziwe Centre, Lilongwe, Malawi.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
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19
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Zhou G, Li X, Qiao S, Shen Z, Zhou Y. Influence of Side Effects on ART Adherence Among PLWH in China: The Moderator Role of ART-Related Knowledge. AIDS Behav 2018; 22:961-970. [PMID: 28509998 DOI: 10.1007/s10461-017-1791-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite the medical advancements in HIV treatment, realities of side effects are faced by people living with HIV (PLWH) who receive antiretroviral therapy (ART). Mixed findings have been reported on the association between side effects and ART adherence. However, few studies have explored the combined side effects and behavior-related information on medication adherence. The aim of the current study is to examine moderator role of ART-related knowledge between side effects and ART adherence. A cross-sectional survey was conducted among 2987 PLWH from October 2012 to August 2013 in China. Of the total sample, 2095 patients had received ART and provided ART adherence. Side effects, ART-related knowledge, and ART adherence, as well as potential covariates were assessed. The results revealed that there was a negative relationship of side effects and ART adherence existed among low and medium levels of ART-related knowledge, but not among high level of knowledge. Future interventions to promote HIV medication adherence should focus on providing behavior-related information education among PLWH.
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Affiliation(s)
- Guangyu Zhou
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
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20
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Hu R, Zhang F, Wang V, Dou Z, Shepard C, Zhao D, Liu X, Mu W, Wu Y, Zhao H, Li H. Comparing Outcomes of HIV-Infected Chinese Adults on Antiretroviral Therapy by CD4 Count at Treatment Initiation: A Nationwide Retrospective Observational Cohort Study, 2012-2014. AIDS Patient Care STDS 2017; 31:413-420. [PMID: 28981337 DOI: 10.1089/apc.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The chief concerns for antiretroviral therapy (ART) programs considering removal of CD4+ cell count thresholds for treatment are the increased incidence of ART-related adverse events. A nationwide observational cohort study was conducted among patients who initiated ART in 2012. We divided the eligible patients into three groups: an early ART group with a baseline CD4+ cell count of 500 cells/μL or greater, a standard ART group with a baseline CD4+ cell count between 350 and 499 cells/μL, and a late ART group with a baseline CD4+ cell count between 200 and 349 cells/μL. These patients were followed up to December 31, 2014 and observed for three outcomes: virological failure, treatment nonretention, or time to death. Patients who met the eligibility criteria numbered at 26,752. Out of all study participants, 20,827 participants were in late ART group, 4336 were in standard ART group, and 1589 were in early ART group. Patients in late ART group were more likely to become virally suppressed 12 and 24 months after treatment initiation than patients in early ART group [adjusted odds ratio (aOR) 0.81; 95% CI, 0.69-0.95 and aOR, 0.78; 95% CI, 0.65-0.94]. Treatment nonretention was also less likely to occur among patients in late ART group than early ART group 12 months after treatment initiation (aOR, 0.85; 95% CI, 0.75-0.96). Compared with early ART group, neither standard ART group nor late ART group had a statistically significant difference in the time-to-death analysis. Late ART initiates were more likely to be virally suppressed and retained on treatment than early ART initiates. The importance of treatment retention and adherence should be emphasized for high CD4+ patients newly initiated to ART therapy through education and counseling programs.
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Affiliation(s)
- Ran Hu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Vania Wang
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Zhihui Dou
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Colin Shepard
- Global AIDS Program, US Centres for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xia Liu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Weiwei Mu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yasong Wu
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Huiqin Li
- Yunnan AIDS Care Center, Kunming, China
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21
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Zhou G, Li X, Qiao S, Zhou Y, Shen Z. Psychological and behavioral barriers to ART adherence among PLWH in China: role of self-efficacy. AIDS Care 2017; 29:1533-1537. [PMID: 28490197 DOI: 10.1080/09540121.2017.1327648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Globally, optimal adherence to antiretroviral therapy (ART) is insufficient despite it is critical for maximum clinical benefits and treatment success among people living with HIV (PLWH). Many factors have been evidenced to influence medication adherence, including perceived barriers and self-efficacy. However, limited data are available regarding to psychological and behavioral barriers to ART adherence in China. Moreover, few studies have examined the mechanism of these two factors underlying HIV medication adherence. The aim of the current study is to examine the mediating role of adherence self-efficacy between perceived barriers and ART adherence among PLWH. Cross-sectional data were obtained from 2095 PLWH in Guangxi China who provided data on ART adherence. Participants reported their medication adherence, self-efficacy, barriers to ART adherence, as well as background characteristics. Results indicated a significant indirect effect from perceived barriers to medication adherence through adherence self-efficacy. Higher perceived psychological and behavioral barriers to ART adherence were related to lower adherence self-efficacy, which in turn was related to lower ART adherence. Self-efficacy could buffer the negative effects of perceived barriers on ART adherence. Future interventions to promote HIV medication adherence are recommended to focus on eliminating psychological and behavioral barriers, as well as increasing adherence self-efficacy.
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Affiliation(s)
- Guangyu Zhou
- a Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ) , University of South Carolina Arnold School of Public Health , Columbia , SC , USA.,c School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health , Peking University , Beijing , People's Republic of China
| | - Xiaoming Li
- a Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ) , University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| | - Shan Qiao
- a Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ) , University of South Carolina Arnold School of Public Health , Columbia , SC , USA
| | - Yuejiao Zhou
- b Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Zhiyong Shen
- b Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
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22
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Sun L, Yang SM, Wu H, Chen B, Wang CJ, Li XF. Reliability and validity of the Chinese version of the HIV Treatment Adherence Self-Efficacy Scale in mainland China. Int J STD AIDS 2016; 28:829-837. [PMID: 27733706 DOI: 10.1177/0956462416673922] [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: 12/28/2022]
Abstract
The aim of this study was to translate the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and evaluate its reliability and validity in people living with HIV (PLWHIV) in mainland China. The original HIV-ASES was translated from English into Chinese and adapted for cultural context according to cross-cultural adaptation guidelines. A cross-sectional survey investigating 1742 PLWHIV receiving antiretroviral treatment was conducted. Exploratory factor analysis with varimax rotation confirmed the presence of two factors with an accumulated contribution rate of 58.357%. Furthermore, confirmatory factor analysis revealed the model's goodness-of-fit index. The comparative fit index was greater than 0.9 and the overall efficacy of the model was satisfactory. The Cronbach α coefficient of the questionnaire was 0.876 (95% CI: 0.868-0.885), and the correlation coefficient of each item and the total was 0.536-0.660 ( P < 0.01). The Chinese version of the HIV-ASES has high reliability and validity; however, the individual item requires some adjustment.
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Affiliation(s)
- Liang Sun
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shu-Min Yang
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hui Wu
- 2 Department of General Medicine, College of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Bing Chen
- 3 Sanmenxia Center for Disease Control and Prevention, Sanmenxia, China
| | - Chong-Jian Wang
- 4 Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiao-Fang Li
- 1 Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
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