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Kaur A, James TA, Brown MJ. Coping and ART adherence self-efficacy among people living with HIV in South Carolina. AIDS Care 2022; 35:989-994. [PMID: 35621305 DOI: 10.1080/09540121.2022.2079600] [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: 10/18/2022]
Abstract
In the US, more than 50% of new HIV infections are reported in southern states. Besides, the incidence rate of HIV in South Carolina is 17 per 100,000 population. Regardless of improved quality of life with the advent of ART, coping with stressors may influence ART adherence self-efficacy. This study assessed the association between coping strategies and ART adherence self-efficacy among people living with HIV (PLWH) in South Carolina. Cross-sectional data were obtained from 402 PLWH attending a large immunology center in South Carolina in 2018. Unadjusted and adjusted linear regression models were used to determine the association between coping strategies and ART adherence self-efficacy. Alcohol or drug use was negatively associated with ART adherence self-efficacy (b = -0.170, 95% CI [-0.255, -0.085], p = 0.0001). Religiosity was positively associated with ART adherence self-efficacy (b = 0.101, 95% CI [0.017, 0.185], p = 0.019). Overall coping and self-motivation were not significantly associated with ART adherence self-efficacy. Accentuating religiosity and attenuating alcohol or drug use as a means of coping may improve ART adherence self-efficacy among PLWH.
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Affiliation(s)
- Amandeep Kaur
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Titilayo A James
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Monique J Brown
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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2
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Carvalho PP, Cunha VFD, Scorsolini-Comin F. Religiosidade/Espiritualidade e Adesão à Terapia Antirretroviral em Pessoas Vivendo com HIV. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais.
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3
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Doolittle BR, McGinnis K, Ransome Y, Fiellin D, Justice A. Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study. AIDS Behav 2021; 25:653-660. [PMID: 32902769 DOI: 10.1007/s10461-020-03028-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Religion and spirituality have been associated with higher survival and improved biological markers among people living with HIV/AIDS (PLWH). Prior results have largely been among small cohort studies. We examined the association using a larger sample and longitudinal data from the Veterans Aging Cohort Study (VACS) years 2002-2012 (n = 3,685). Attending services at least monthly was associated with higher social support (80% vs 75%, p = 0.002), less unhealthy alcohol use (35% vs 39%, p = 0.006), less marijuana use in the past year (23% vs 32%, p < 0.001), less overall drug use within the past year (27% vs 31%, p = 0.01), and lower depression (20% vs 24%, p = 0.004). Attending services monthly was associated with a reduced mortality risk adjusting for age, race, gender, education, MSM, HCV, VL, CD4, and adherence to ARV (adjusted HazardRatio [aHR] = 0.89, 0.80-0.99). However, after controlling for smoking status, this association of mortality and religious attendance became non-significant (aHR = 0.93, 0.84-1.04).
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Affiliation(s)
- Benjamin R Doolittle
- Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 8030, Yale Station, New Haven, CT, 06520, USA.
| | - Kathleen McGinnis
- VACS Coordination Center, Veterans Administration Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Yusuf Ransome
- Yale University School of Public Health, 60 College Street LEPH, New Haven, CT, 06510, USA
| | - David Fiellin
- VACS Coordination Center, Veterans Administration Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Amy Justice
- VACS Coordination Center, Veterans Administration Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
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4
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The HIV Care Continuum in Small Cities of Southern New England: Perspectives of People Living with HIV/AIDS, Public Health Experts, and HIV Service Providers. AIDS Behav 2021; 25:897-907. [PMID: 33001353 DOI: 10.1007/s10461-020-03049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
The HIV care continuum (HCC), comprised of five steps (screening, linkage to care, treatment initiation, retention, and viral suppression), is used to monitor treatment delivery to people living with HIV (PLWH). The HCC has primarily focused on large urban or metropolitan areas where the situation may differ from that in smaller cities. Three themes (i.e., knowledge, stigma, stability) that shaped HCC outcomes were identified from analysis of two qualitative studies involving HIV service providers, public health experts, and PLWH in smaller cities of southern New England. The findings suggest that enhancing HCC outcomes require a multiprong approach that targets both the individual and organizational levels and includes interventions to increase health literacy, staff communication skills, universal screening to assess patients' religiosity/spirituality and supplemental service needs. Interventions that further ensure patient confidentiality and the co-location and coordination of HIV and other healthcare services are particularly important in smaller cities.
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5
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Pan SW, Smith MK, Carpiano RM, Fu H, Ong JJ, Huang W, Tang W, Tucker JD. Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China. Int J Behav Med 2020; 27:602-608. [PMID: 32415590 DOI: 10.1007/s12529-020-09883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China. METHOD In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15). RESULTS Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75). CONCLUSION Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.
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Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences - ES345, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Road, Suzhou Dushu Lake Higher Education Town, Suzhou, 215123, Jiangsu, China. .,UNC-Project China, Guangzhou, China.
| | - M Kumi Smith
- UNC-Project China, Guangzhou, China.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, CA, USA.,Department of Sociology, University of California, Riverside, CA, USA.,Center for Healthy Communities, University of California, Riverside, CA, USA
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jason J Ong
- UNC-Project China, Guangzhou, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Weiming Tang
- UNC-Project China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Xiao X, Chen C, Gao C, Wang H, Reynolds NR. Ways of coping mediate the relationship between self-efficacy for managing HIV and acceptance of illness among people living with HIV. J Adv Nurs 2020; 76:2945-2954. [PMID: 32893375 DOI: 10.1111/jan.14488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 12/01/2022]
Abstract
AIM The purpose of this study was to examine the relationship between self-efficacy for managing HIV and acceptance of illness and to identify the potential mediation effect of active coping and passive coping on this relationship. DESIGN The study used a cross-sectional survey. METHODS A sample of 555 people living with HIV were recruited from September-December 2018 in the HIV clinic of a tertiary general hospital in Changsha, China. Survey data were collected through face-to-face interviews that included measures of sociodemographic and HIV-related clinical characteristics, Acceptance of Illness Scale, the Simplified Coping Style Questionnaire and the Self-efficacy for Managing Chronic Disease Scale. Step-by-step linear regression models combined with bootstrap testing were used to test the relationships when controlling for gender and HIV diagnosis duration. RESULTS Self-efficacy was positively related to acceptance of illness and this relationship was partially mediated by both active coping and passive coping. Acceptance of illness increased by 0.175 for every point increase in self-efficacy indirectly through active coping, while acceptance of illness decreased by 0.034 for every point increase in self-efficacy via passive coping. CONCLUSION The findings highlighted the importance of self-efficacy for managing HIV and ways of coping, especially active coping, for illness acceptance. IMPACT The findings suggested that interventions that improve confidence in managing HIV and active coping may enhance the illness acceptance of people living with HIV.
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Affiliation(s)
- Xueling Xiao
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China.,Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Chen Chen
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Chang Gao
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya School of Nursing of Central South University, Changsha, Hunan, China
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7
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Wagner GJ, Ghosh-Dastidar B, Mukasa B, Linnemayr S. Changes in ART Adherence Relate to Changes in depression as Well! Evidence for the Bi-directional Longitudinal Relationship Between Depression and ART Adherence from a Prospective Study of HIV Clients in Uganda. AIDS Behav 2020; 24:1816-1824. [PMID: 31813077 PMCID: PMC7228829 DOI: 10.1007/s10461-019-02754-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Studies have documented how levels and change in depression correspond to ART non-adherence. However, few studies have examined how levels of and change in adherence may relate to levels of and change in depression, although one might expect mental health to be related to physical health and how successful one is in managing disease. To assess the bidirectional nature of the association between these two constructs, we examined data from a prospective trial of an ART adherence intervention in Uganda that followed 143 participants over 20 months. Adherence was measured using electronic monitoring caps; non-adherence was defined as missing > 10% of prescribed doses; self-reported depression was measured using the Patient Health Questionnaire (PHQ-9), and PHQ-9 > 4 defined the presence of at least minor depression. Adjusted linear and logistic regression models were used to examine the longitudinal relationships between depression and non-adherence. At baseline, 40.6% had at least minor depression and 37.1% were non-adherent. Time varying change in the classification of depression (e.g., becoming depressed) predicted change in non-adherence status (e.g., becoming non-adherent), and this association remained when examining continuous measures of the constructs. Similarly, time varying measures of increases in non-adherence predicted increases in depression, regardless of whether continuous or binary classification measures were used. A temporal trend of increased non-adherence over time was observed, and this was accelerated by an increase in depression. Furthermore, those who had at least minor depression at baseline were more likely to be non-adherent at follow-up. These findings support the potential benefits of depression care and adherence support for improving adherence and mental health, respectively, and call for further research to examine such benefits.The trial has been registered with ClinicalTrials.gov (NCT02503072).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3201, USA.
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8
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Fleischer L, Avery A. Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV. SAGE Open Med 2020; 8:2050312120915405. [PMID: 32435479 PMCID: PMC7222653 DOI: 10.1177/2050312120915405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/13/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives: Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy. Methods: We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States. Results: We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team. Conclusion: Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.
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Affiliation(s)
- Lisa Fleischer
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann Avery
- Division of Infectious Disease, MetroHealth Medical Center, Cleveland, OH, USA
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9
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Abstract
Abstract
Objective
To explore the concept of adherence in the context of rehabilitation of patients with chronic illnesses. This concept analysis is helpful in predicting health behaviors and intentions including physical activity and dietary behaviors in patients with chronic illnesses.
Methods
The framework of Walker and Avant was used to analyze the concept of adherence.
Results
Adherence is defined as the extent to which a person’s behavior, such as taking medication, following a diet, and/or executing lifestyle changes, corresponds to agreed recommendations from a health-care provider. The antecedents of adherence are the biomedical status of the individual, social support, self-efficacy, and education. Self-report questionnaires and patient self-reporting are the most common measurement tools of adherence. Thus, the reliable and valid instrument of monitoring adherence in the clinical settings is challenging.
Conclusions
Analyzing the concept of adherence is necessary to help understand how best to promote adherence to improve health-related outcomes.
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10
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Ransome Y, Mayer KH, Tsuyuki K, Mimiaga MJ, Rodriguez-Diaz CE, Srithanaviboonchai K, Friedman RK, Limbada M, Safren SA. The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study. AIDS Behav 2019; 23:459-474. [PMID: 29956116 PMCID: PMC6310676 DOI: 10.1007/s10461-018-2206-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Early and sustained antiretroviral therapy (ART) adherence can suppress the HIV virus in individuals and reduce onward transmission of HIV in the population. Religiosity has been associated with better HIV clinical outcomes. Data are from a longitudinal, observational study of 749 HIV-infected individuals from Brazil, Zambia, and Thailand (HPTN 063). Ordered logistic regression assessed whether religious service attendance was associated with ART adherence (self-reported and plasma HIV-RNA) and moderated the association between alcohol problems and ART adherence. In each country, > 80% of participants reported high self-reported ART adherence (good/very good/excellent). Religious service attendance exceeded 85% but was statistically unrelated to adherence. In combined-country models, (p = 0.03) as alcohol problems increased, the probability of high self-reported ART adherence, as well as viral-load, became weaker at higher compared to low service attendance frequency. Future studies should evaluate spirituality variables and replicate the moderation analyses between religious attendance and alcohol problems.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06510, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kiyomi Tsuyuki
- Division of Global Public Health, School of Medicine, University of San Diego, San Diego, CA, USA
| | - Matthew J Mimiaga
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Ruth K Friedman
- Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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11
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Badanta-Romero B, de Diego-Cordero R, Rivilla-García E. Influence of Religious and Spiritual Elements on Adherence to Pharmacological Treatment. JOURNAL OF RELIGION AND HEALTH 2018; 57:1905-1917. [PMID: 29582335 DOI: 10.1007/s10943-018-0606-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of this study is to know the influence of religious/spiritual elements on the adherence to pharmacological therapy. The descriptors used for this literature review were "medicine, medication, drug, or treatment," "adherence to treatment," and "religion or spirituality or faith or prayer" in different databases (CINAHL, PsycINFO, PubMed). Finally, 23 articles were selected. Articles available in full text, published between 2010 and 2017, in English or Spanish were included. The results showed that some studies relate positively the R/S and therapeutic adherence, but others determine an opposite or even mixed effect, mainly addressing pathologies such as HIV and other chronic diseases. The influence of religiosity/spirituality on therapeutic adherence requires that health professionals acquire sensitivity and competence to address these issues with their patients.
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Affiliation(s)
- Bárbara Badanta-Romero
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 6 Avenzoar St., 41009, Seville, Spain
| | - Rocío de Diego-Cordero
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 6 Avenzoar St., 41009, Seville, Spain.
| | - Estefanía Rivilla-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 6 Avenzoar St., 41009, Seville, Spain
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12
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Mills SD, Arredondo EM, Perez LG, Haughton J, Roesch SC, Malcarne VL. Psychometric Properties of the God Locus of Health Control Scale in Churchgoing Latinas. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2018; 40:227-239. [PMID: 30906111 DOI: 10.1177/0739986318762464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study evaluated the psychometric properties of the Spanish version of the God Locus of Health Control scale, a measure of the extent to which an individual believes God has control over one's health, among a sample of churchgoing Latinas (N = 398). Confirmatory factor analysis showed support for a one-factor structure and internal consistency reliability, as measured by Cronbach's coefficient alpha, was good. Evidence for convergent validity was demonstrated by significant correlations in the expected magnitudes and directions with two measures of perceived religious involvement in health. These results suggest that the God Locus of Health Control scale can be used to examine the extent to which God is perceived to control an individual's health among Latinas.
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Affiliation(s)
- Sarah D Mills
- Department of Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Elva M Arredondo
- Graduate School of Public Health, San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, California
| | - Lilian G Perez
- Graduate School of Public Health, San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, California.,Graduate School of Public Health, San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health, San Diego, California
| | - Jessica Haughton
- Graduate School of Public Health, San Diego State University, Institute for Behavioral and Community Health (IBACH), San Diego, California
| | - Scott C Roesch
- Department of Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.,Department of Psychology, San Diego State University, San Diego, California
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13
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Ammon N, Mason S, Corkery JM. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. Public Health 2018; 157:20-31. [PMID: 29501984 DOI: 10.1016/j.puhe.2017.12.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Eighty-two percent of human immunodeficiency virus (HIV)-positive adolescents live in Sub-Saharan Africa (SSA). Despite the availability of antiretroviral therapy (ART), adherence levels are suboptimal, leading to poor outcomes. This systematic review investigated factors impacting ART adherence among adolescents in SSA, including religious beliefs and intimate relationships. METHODS A systematic review was conducted between June and August 2016 using eight electronic databases, including Cochrane and PubMed. Published, ongoing and unpublished research, conducted in SSA from 2004 to 2016, was identified and thematic analysis was used to summarise findings. RESULTS Eleven studies from eight SSA countries, published in English between 2011 and 2016, reported on factors impacting ART adherence among adolescents living with HIV (ALHIV). Forty-four barriers and 29 facilitators to adherence were identified, representing a complex web of factors. The main barriers were stigma, ART side-effects, lack of assistance and forgetfulness. Facilitators included caregiver support, peer support groups and knowledge of HIV status. CONCLUSIONS Stigma reflects difficult relations between ALHIV and their HIV-negative peers and adults. Most interventions target only those with HIV, suggesting a policy shift towards the wider community could be beneficial. Recommendations include engaging religious leaders and schools to change negative societal attitudes. Limitations of the review include the urban settings and recruitment of predominantly vertically infected participants in most included studies. Therefore, the findings cannot be extrapolated to ALHIV residing in rural locations or horizontally infected ALHIV, highlighting the need for further research in those areas.
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Affiliation(s)
- N Ammon
- Picturing Health, PO Box 122, Zomba, Malawi.
| | - S Mason
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - J M Corkery
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK.
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14
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Michlig GJ, Westergaard RP, Lam Y, Ahmadi A, Kirk GD, Genz A, Keruly J, Hutton H, Surkan PJ. Avoidance, meaning and grief: psychosocial factors influencing engagement in HIV care. AIDS Care 2018; 30:511-517. [PMID: 29338328 DOI: 10.1080/09540121.2018.1425366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although the introduction of antiretroviral therapy has rendered HIV a chronic illness, inconsistent engagement in HIV care by key populations limits its public health impact. Poor engagement in care is especially prevalent among vulnerable populations with mental health and substance use disorders. Beyond structural and health system considerations, psychosocial factors may present challenges to sustained engagement. We conducted a qualitative study using in-depth interviews with 31 primarily African American, urban-based individuals, many with past or current drug use and mental disorders, living with HIV. Participants identified several psychosocial barriers that detract from their motivation to attend appointments and take medication. These included mental distress or detachment over a lack of purpose in life; denial about the need to be engaged in care; insufficient trust in the efficacy of care or the health system; deaths of loved ones leading to bereavement or loss of social support; and engagement in specific avoidance behaviors like drugs and alcohol. The study findings suggest that more comprehensive HIV care, which integrates mental health and substance abuse services in order to enhance meaning and address coping and grief, may be important. Considering these services in addition to improving the logistical components of care such as cues/reminders, accessibility, and patient-provider communication may improve intervention packages.
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Affiliation(s)
- Georgia J Michlig
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ryan P Westergaard
- b University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Yukyan Lam
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Azal Ahmadi
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Gregory D Kirk
- a International Health , Johns Hopkins University , Baltimore , MD , USA.,c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Andrew Genz
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Jeanne Keruly
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Heidi Hutton
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Pamela J Surkan
- a International Health , Johns Hopkins University , Baltimore , MD , USA
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15
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Dalmida SG, McCoy K, Koenig HG, Miller A, Holstad MM, Thomas T, Clayton-Jones D, Grant M, Fleming T, Wirani MM, Mugoya G. Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates. JOURNAL OF RELIGION AND HEALTH 2017; 56:2144-2161. [PMID: 28285439 PMCID: PMC9897031 DOI: 10.1007/s10943-017-0377-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (<90-95%) contributes to antiretroviral resistance and worse medical outcomes, including more rapid progression to AIDS and death. Psychosocial factors and religion/spirituality (R/S) have a significant impact on ART adherence, but the findings are mixed. The purpose of this study was to examine religious and psychosocial correlates and predictors of ≥90% ART adherence in PLWH. A cross-sectional study was conducted with a sample of 292 outpatient PLWH in the Southeastern USA. Participants completed computerized surveys. The mean ART adherence percentage was 80.9% and only about half reported ≥90% adherence. There were statistically significant differences in ART adherence rates based on age, depressive symptom status and frequency of religious attendance and prayer. Praying at least once a day was significantly associated with ≥90% ART adherence (OR = 2.26, 95% CI [1.06-4.79], p < 0.05). Social support satisfaction was also significantly associated with ART adherence (OR = 1.52, 95% CI [1.11-2.08], p < 0.05) and energy/fatigue/vitality (OR = 1.03, 95% CI [1.00-1.05], p < 0.05).
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Affiliation(s)
- Safiya George Dalmida
- Capstone College of Nursing, The University of Alabama, 650 University Blvd, Tuscaloosa, AL, 35487, USA.
| | - Katryna McCoy
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aretha Miller
- College of Health Sciences, Walden University, Minneapolis, MN, USA
| | | | - Tami Thomas
- Nicole Werthiem College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Dora Clayton-Jones
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Terri Fleming
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - George Mugoya
- College of Education, The University of Alabama, Tuscaloosa, AL, USA
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16
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Abstract
Supplemental Digital Content is Available in the Text. Background: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. Conceptual Framework: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social–ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. Discussion: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.
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Hag Hamed D, Daniel M. The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims. Glob Health Promot 2017; 26:15-22. [PMID: 28730875 DOI: 10.1177/1757975917715884] [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: 11/16/2022]
Abstract
Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual's control where it is then the individual's free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of 'God doesn't give one what one cannot handle' that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants' response to diabetes.
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Affiliation(s)
- Dana Hag Hamed
- Research Centre for Health Promotion, University of Bergen, Norway
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18
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Wouters E, Booysen FLR, Masquillier C. Who Should We Target? The Impact of Individual and Family Characteristics on the Expressed Need for Community-Based Treatment Support in HIV Patients in South Africa. PLoS One 2016; 11:e0163963. [PMID: 27741239 PMCID: PMC5065171 DOI: 10.1371/journal.pone.0163963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/16/2016] [Indexed: 12/04/2022] Open
Abstract
Reviews of impact evaluations of community-based health workers and peer support groups highlight the considerable variability in the effectiveness of such support in improving antiretroviral treatment (ART) outcomes. Evidence indicates that community-based support interventions targeting patients known to be at risk will probably display better results than generic interventions aimed at the entire population of people living with HIV. It is however difficult to identify these at-risk populations, rendering knowledge on the characteristics of patients groups who are in need of community-based support a clear research priority. The current study aims to address the knowledge gap by exploring the predictors of the willingness to (1) receive the support from a community-based health worker or (2) to participate in a support group in public sector ART programme of the Free State Province of South Africa. Based on the Individual-Family-Community framework for HIV research, the study employs a comprehensive approach by not only testing classical individual-level but also family-level predictors of the willingness to receive community-based support. In addition to individual-level predictors—such as age, health status and coping styles—our analysis demonstrated the importance of family characteristics. The results indicated that discrepancies in the family’s changeability level were an important predictor of the demand for community-based support services. Conversely, the findings indicated that patients living in a family more flexible than deemed ideal are more likely to require the support of a community health worker. The current study expands theory by indicating the need to acknowledge all social ecological levels in the study of chronic HIV care. The detection of both individual level and family level determinants of the expressed need for community-based support can inform health policy to devise strategies to target scarce resources to those vulnerable patients who report the greatest need for this support. In this way, the study results are a first step in an attempt to move away from generic, broad based community-based interventions towards community support that is tailored to the patient needs at both the individual and family level.
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Affiliation(s)
- Edwin Wouters
- Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa
- * E-mail:
| | | | - Caroline Masquillier
- Department of Sociology and Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium
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Van Wagoner N, Elopre L, Westfall AO, Mugavero MJ, Turan J, Hook EW. Reported Church Attendance at the Time of Entry into HIV Care is Associated with Viral Load Suppression at 12 Months. AIDS Behav 2016; 20:1706-12. [PMID: 26936149 DOI: 10.1007/s10461-016-1347-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Southeast has high rates of church attendance and HIV infection rates. We evaluated the relationship between church attendance and HIV viremia in a Southeastern US, HIV-infected cohort. Viremia (viral load ≥200 copies/ml) was analyzed 12 months after initiation of care. Univariate and multivariable logistic regression models were fit for variables potentially related to viremia. Of 382 patients, 74 % were virally suppressed at 12 months. Protective variables included church attendance (AOR 0.5; 95 % CI 0.2, 0.9), being on antiretroviral therapy (AOR 0.01; 95 % CI 0.004, 0.04), CD4(+) T lymphocyte count 200-350 cells/mm(3) at care entry (AOR 0.3; 95 % 0.1, 0.9), and education (AOR 0.5; 95 % CI 0.2, 0.9). Variables predicting viremia included black race (AOR 3.2; 95 % CI 1.4, 7.4) and selective disclosure of HIV status (AOR 2.7; 95 % CI 1.2, 5.6). Church attendance may provide needed support for patients entering HIV care for the first time.
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Affiliation(s)
- Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Latesha Elopre
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
| | - Andrew O Westfall
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Janet Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward W Hook
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA
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Medved Kendrick H. Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature. AIDS Care 2016; 29:1-13. [PMID: 27410058 DOI: 10.1080/09540121.2016.1201196] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Much attention has been given to the relationship between religion/spirituality (R/S) and HIV in recent years, but comparatively little has been explored in regard to R/S and HIV testing, retention in care, and adherence to medication. Religious views concerning HIV risk behavior pose challenges to communication and education about sexual health in religious communities and may serve as barriers to HIV treatment and care. Conversely, religious coping and spiritual well-being, as well as social support could serve as facilitators to HIV treatment and care. This study aims to fill a gap in the literature by addressing the following questions: (1) what dimensions of R/S have been found to be factors associated with HIV outcomes?; (2) which R/S factors function as barriers or facilitators to care among people living with HIV (PLWH)?; and (3) which R/S factors, if any, vary across socio-demographic groups? Thirty-three empirical articles were identified for systematic review. Of the 33 empirical studies included, 24 studies found that at least one measure of R/S was associated with better adherence and clinical health outcomes. Twelve studies found at least one measure of R/S to be associated with poorer adherence and clinical health outcomes. Seven of the studies found at least one R/S measure to have no significant association with outcomes. Though all of the studies included in this review focused on R/S experiences of PLWH, there was very little consistency in regard to measurement of R/S. Studies in this review included a wide range of R/S measures, including beliefs, religious/spiritual practices, R/S coping, organizational religion, and many more. Of the 33 studies reviewed, only 9 focused on unique populations such as women, people with histories of substance abuse, immigrants, etc. Findings from this review highlight opportunities for more studies in various populations using standardized R/S measures.
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Affiliation(s)
- Haley Medved Kendrick
- a Department of Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
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21
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Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review. AIDS 2016; 30:1147-62. [PMID: 26919732 DOI: 10.1097/qad.0000000000001068] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
It has been shown that socioeconomic factors are associated with the prognosis of several chronic diseases; however, there is no recent systematic review of their effect on HIV treatment outcomes. We aimed to review the evidence regarding the existence of an association of socioeconomic status with virological and immunological response to antiretroviral therapy (ART). We systematically searched the current literature using the database PubMed. We identified and summarized original research studies in high-income countries that assessed the association between socioeconomic factors (education, employment, income/financial status, housing, health insurance, and neighbourhood-level socioeconomic factors) and virological response, immunological response, and ART nonadherence among people with HIV-prescribed ART. A total of 48 studies met the inclusion criteria (26 from the United States, six Canadian, 13 European, and one Australian), of which 14, six, and 35 analysed virological, immunological, and ART nonadherence outcomes, respectively. Ten (71%), four (67%), and 23 (66%) of these studies found a significant association between lower socioeconomic status and poorer response, and none found a significant association with improved response. Several studies showed that adjustment for nonadherence attenuated the association between socioeconomic status and ART response. Our review provides strong support that socioeconomic disadvantage is associated with poorer response to ART. However, most studies have been conducted in settings such as the United States without universal free healthcare access. Further study in settings with free access to ART could help assess the impact of socioeconomic status on ART outcomes and the mechanisms by which it operates.
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Teshome W, Belayneh M, Moges M, Endriyas M, Mekonnen E, Ayele S, Misganaw T, Shiferaw M, Chinnakali P, Hinderaker SG, Kumar AMV. Who takes the medicine? Adherence to antiretroviral therapy in Southern Ethiopia. Patient Prefer Adherence 2015; 9:1531-7. [PMID: 26604706 PMCID: PMC4631418 DOI: 10.2147/ppa.s90816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Treatment adherence is critical for the success of antiretroviral therapy (ART) for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it in 20 randomly selected ART clinics of Southern Ethiopia. METHODS In this cross-sectional study, we interviewed consecutive HIV patients on first-line antiretroviral regimen attending the clinics in June 2014 using a pretested and structured questionnaire. For measuring adherence, we used 4-day recall method based on "The AIDS Clinical Trial Group adherence assessment tool". Patients were classified as "Incomplete adherence" if they missed any of the doses in the last 4 days. Data were singly entered using EpiData and descriptive analysis, and unadjusted odds ratios were calculated using EpiDataStat software. Multivariate logistic regression analysis was performed using Stata v12.0. RESULTS Of 974 patients interviewed, 539 (56%) were females, and mean age was 35 years. The proportion of patients with incomplete adherence was 13% (95% confidence interval: 11%-15%). In multivariate analysis, factors significantly associated with incomplete adherence included young age, being Protestant Christian, consuming alcohol, being single, and being a member of an HIV association. Psychosocial factors like stigma, depression, and satisfaction to care were not associated with incomplete adherence in the current context. CONCLUSION The overall adherence to ART was good. However, there were certain subgroups with incomplete adherence who need special attention. The health care providers (especially counselors) need to be aware of these subgroups and tailor their counseling to improve adherence among these groups. Exploratory qualitative studies may help uncover the exact reasons for incomplete adherence.
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Affiliation(s)
- Wondu Teshome
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Correspondence: Wondu Teshome, PO Box 898, Hawassa, Ethiopia, Tel +251 91 176 1805, Email
| | - Mihretu Belayneh
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mathewos Moges
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Misganu Endriyas
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Emebet Mekonnen
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Sinafiksh Ayele
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Tebeje Misganaw
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Mekonnen Shiferaw
- Research Technology Transfer Process Unit, SNNP Regional Health Bureau, Hawassa, Ethiopia
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India
| | | | - Ajay MV Kumar
- The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
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23
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Azzopardi C, Wade M, Salter R, Macdougall G, Shouldice M, Read S, Bitnun A. Medical nonadherence in pediatric HIV: psychosocial risks and intersection with the child protection system for medical neglect. CHILD ABUSE & NEGLECT 2014; 38:1766-1777. [PMID: 25262535 DOI: 10.1016/j.chiabu.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 06/03/2023]
Abstract
Nonadherence to antiretroviral treatment has serious health implications for HIV-infected children, at times warranting referral to child protective services (CPS). The current study of 134 children with perinatally acquired HIV infection aimed to investigate rates of treatment adherence and CPS involvement, multilevel variables associated with nonadherence, and the manner in which these risks operated together in the prediction of adherence outcomes. Risk factors for nonadherence were grouped on the basis of confirmatory factor models, and factor score regression was carried out to determine which factors were uniquely predictive of adherence. A series of indirect effects models were then tested in order to examine how these factors operated together in the prediction of adherence. Results showed that almost half of the sample demonstrated suboptimal adherence to treatment, and in one-fifth, CPS was involved for medical neglect. Caregiver Health, Caregiver Involvement, Caregiver Acceptance, and Child Adaptation were predictive of nonadherence, and together explained 54% of the variance in treatment adherence. There were significant indirect effects of Caregiver Health on adherence that operated through Caregiver Involvement and Child Adaptation and an indirect effect of Caregiver Involvement on adherence through Child Adaptation. Findings extend current literature that has independently linked various factors predictive of medical adherence in pediatric HIV by showing separate but simultaneous associations with nonadherence and unique pathways to adherence involving multilevel risks. Healthcare and child welfare implications are discussed.
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Affiliation(s)
- Corry Azzopardi
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada
| | - Mark Wade
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Department of Applied Psychology and Human Development, Toronto, Ontario, Canada
| | - Robyn Salter
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - Georgina Macdougall
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - Michelle Shouldice
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Stanley Read
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Kremer H, Ironson G, Kaplan L, Stuetzele R, Baker N, Fletcher MA. Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years. AIDS Care 2014; 27:71-9. [PMID: 25297848 DOI: 10.1080/09540121.2014.952220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study of 177 people living with HIV, we examined if spiritual coping leads to slower HIV disease progression (CD4 cells, viral load [VL]), and more positive health behaviors (adherence, safer sex, less substance use). Prior research suggests that physicians' assessment of spiritual coping can be an interventional aid in promoting positive spiritual coping. Longitudinal spiritual coping was rated using qualitative content analysis of six-monthly interviews/essays. Positive spiritual coping (65%) was predominant over negative (7%), whereas 28% did not make significant use of spirituality as a means to cope. Spiritual coping was associated with less substance use disorder but not with less sexual risk behavior. Hierarchical linear modeling demonstrated that spiritual coping predicted sustained undetectable VL and CD4-cell preservation over four years, independent of sociodemographics, baseline disease status, and substance use disorder. Achieving undetectable VL significantly increased over time in participants with positive spiritual coping but decreased among those with negative spiritual coping. For every participant with positive spiritual coping achieving undetectable VL, four with negative spiritual coping reported with detectable/transmittable HIV. Notably, even when controlling for the effect of VL suppression, CD4-cell decline was 2.25 times faster among those engaged in negative versus positive spiritual coping. In conclusion, spiritual coping is associated with positive health behaviors, such as maintaining long-term VL suppression and less onset/relapse of substance use disorder over time. Among those who are sexually active, positive spiritual coping reduces the risk of HIV transmission via VL suppression but may not prevent the transmission of other STDs because spiritual coping is not related to safer sexual behavior. Notably, the association between spiritual coping and immune preservation was direct (i.e., not explained by VL suppression), suggesting potential psychoneuroimmunological pathways. Thus, assessment of spiritual coping may be an important area of intervention to achieve undetectable VL, reduce HIV disease progression, and prevent substance use onset/relapse.
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Affiliation(s)
- Heidemarie Kremer
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
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25
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014; 12:142. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/preaccept-1453408941291432] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. METHODS We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. RESULTS In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. CONCLUSIONS These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
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Affiliation(s)
- Nienke Langebeek
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Elizabeth H Gisolf
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Peter Reiss
- />Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Sigrid C Vervoort
- />Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Thóra B Hafsteinsdóttir
- />Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Clemens Richter
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Mirjam AG Sprangers
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Pythia T Nieuwkerk
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands
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26
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/s12916-014-0142-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. Results In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, Netherlands.
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Lyon ME, Garvie P, He J, Malow R, McCarter R, D'Angelo LJ. Spiritual well-being among HIV-infected adolescents and their families. JOURNAL OF RELIGION AND HEALTH 2014; 53:637-53. [PMID: 23104266 PMCID: PMC3568454 DOI: 10.1007/s10943-012-9657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Congruence in spirituality between HIV+ adolescent (n = 40)/family (n = 40) dyads and psychological adjustment and quality of life were assessed, using the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy, Beck Depression Inventory-II, Beck Anxiety Inventory and Pediatric Quality of Life Inventory at baseline and 3-month post-intervention. Adolescents were 60 % female and 92 % African American. Congruence in spirituality between adolescent/surrogate dyads remained unchanged at 3 months. High congruence existed for "having a reason for living"; rejection of "life lacks meaning/purpose" and "HIV is a punishment from God." Adolescents were less likely to forgive the harm others caused them than their families.
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Affiliation(s)
- Maureen E Lyon
- Center for Translational Research, Children's Research Institute, Children's National Medical Center, Room M7658, 111 Michigan Avenue, N.W., Washington, DC, 20010-2970, USA,
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Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM, Bimirew MA, Kassie DM. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia. PLoS One 2014; 9:e97353. [PMID: 24828585 PMCID: PMC4020856 DOI: 10.1371/journal.pone.0097353] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country's ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia. METHODS Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English. RESULTS Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART. CONCLUSIONS Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved patient outcomes.
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Affiliation(s)
- Woldesellassie M. Bezabhe
- Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
- College of Medicine and Health Science, Bahir-Dar University, Gojjam, Ethiopia
| | - Leanne Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Luke R. Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Gregory M. Peterson
- Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Mekides A. Bimirew
- Department of Internal Medicine, Felege-Hiwot Hospital, Gojjam, Ethiopia
| | - Desalew M. Kassie
- Department of Internal Medicine, Gondar University Hospital, Gondar, Ethiopia
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Vyas KJ, Limneos J, Qin H, Mathews WC. Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons. AIDS Care 2014; 26:983-7. [DOI: 10.1080/09540121.2014.882486] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kartavya J. Vyas
- Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
- Department of Deployment Health Research, Naval Health Research Center, San Diego, CA, USA
- Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanne Limneos
- Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
| | - Huifang Qin
- Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
| | - William C. Mathews
- Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
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Bernstein K, D'Angelo LJ, Lyon ME. An exploratory study of HIV+ adolescents' spirituality: will you pray with me? JOURNAL OF RELIGION AND HEALTH 2013; 52:1253-1266. [PMID: 22258733 DOI: 10.1007/s10943-012-9565-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aims of the study were (1) to determine whether adolescents find it acceptable to have physicians explore their spiritual beliefs as part of their medical care, (2) to characterize the role of spirituality and religious beliefs in adolescents with and without HIV, and (3) to examine associations between spirituality/religion and quality of life. Adolescents receiving their medical care at an urban Adolescent Health Clinic completed a study-specific questionnaire about spiritual inquiry by their physician, the Brief Multidimensional Measurement of Religiousness/Spirituality, and the Pediatric Quality of Life Inventory 4.0. Chi-squared analysis, Fischer's exact test, and t tests were used to assess associations. A total of 45 participants enrolled: 19 HIV+ (53% vertical transmission) and 26 HIV-; mean age 17.2 years; 80% African American. Four out of 45 (9%) had ever been asked by their doctor about their spiritual/religious beliefs, and only 8 (18%) had ever shared these beliefs with their healthcare provider. Most teens wanted their provider to ask them about their spiritual beliefs during some visits, especially when dealing with death/dying or chronic illness (67%). Those with HIV were more likely to endorse wanting their doctors to pray with them (42% vs. 15%), feeling "God's presence" (Mean = 3.95 vs. 2.83), being "part of a larger force" (Mean = 2.58 vs. 1.69), and feeling "God had abandoned them" (Mean = 1.63 vs. 1.15). There are certain circumstances in which healthcare providers should include a spiritual history with teenage patients. Few differences emerged in the teens studied with and without HIV.
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Affiliation(s)
- Karen Bernstein
- Department of Pediatrics, Advocate Lutheran General Children's Hospital, Park Ridge, IL, USA
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Westreich D, Rosenberg M, Schwartz S, Swamy G. Representation of women and pregnant women in HIV research: a limited systematic review. PLoS One 2013; 8:e73398. [PMID: 24009750 PMCID: PMC3751870 DOI: 10.1371/journal.pone.0073398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings. OBJECTIVE To characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations. DATA SOURCES All HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS. STUDY ELIGIBILITY CRITERIA HIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data. STUDY APPRAISAL AND SYNTHESIS METHODS Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors. RESULTS In total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9). LIMITATIONS Data were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers' ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.
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Affiliation(s)
- Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Crozatti MTL, França-Junior I, Rodrigues R, Carneiro Ferrão MDS, Brigido LFM, Della Negra M, Campéas AE, Castilho Raymundo ME, Marques SR, Waldman EA. Antiretroviral treatment adherence in childhood and adolescence: multidisciplinary team as an associated factor in Brazil. AIDS Care 2013; 25:1462-9. [PMID: 23452050 DOI: 10.1080/09540121.2013.774312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75-5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03-6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08-4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25-0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with one's grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.
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Brown JL, Littlewood RA, Vanable PA. Social-cognitive correlates of antiretroviral therapy adherence among HIV-infected individuals receiving infectious disease care in a medium-sized northeastern US city. AIDS Care 2013; 25:1149-58. [PMID: 23311323 DOI: 10.1080/09540121.2012.752566] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High levels of antiretroviral therapy (ART) adherence are required to achieve optimal viral suppression. To better understand mechanisms associated with ART adherence, this study characterized demographic and social-cognitive correlates of ART adherence among HIV-infected individuals from a medium-sized northeastern US city (n=116; 42% female; 43% African-American). Participants completed an audio computer-assisted self-interviewing survey assessing demographics, social-cognitive constructs, and ART adherence, and the participants' most recent viral load was obtained from their medical charts. Suboptimal ART adherence (taking less than 95% of prescribed medications during the past month) was reported by 39% of participants and was associated with being female, being a minority, and having a detectable viral load. In a hierarchical logistic regression analysis, greater than 95% ART adherence was associated with higher levels of adherence self-efficacy (AOR =1.1; p=0.015), higher perceived normative beliefs about the importance of ART adherence (AOR=1.3; p=0.03), and lower concern about missing ART doses (AOR=0.63; p=0.002). Adherence did not differ based on ART outcome expectancies, ART attitudes, or the perceived necessity of ART. In fact, most participants endorsed positive attitudes and expectancies regarding the need for and effectiveness of ART. Taken together, results indicate that suboptimal adherence remains high among HIV-infected minority women, a subpopulation that experiences particularly high rates of chronic stress due to both illness-specific stressors and broader environmental stressors. Consistent with social-cognitive theory, adherence problems in our sample were linked with deficits in self-efficacy as well as perceived norms and behavioral intentions that do not support a goal of 100% adherence. We suggest that interventions to improve adherence informed by social-cognitive theory (1) target patients who are at risk for adherence problems, (2) provide a supportive environment that promotes high rates of adherence, and (3) address inaccurate beliefs regarding optimal adherence levels.
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Affiliation(s)
- Jennifer L Brown
- a Department of Behavioral Sciences and Health Education , Emory University , Atlanta , GA , USA
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Martinez DA, Goggin K, Catley D, Gerkovich MM, Williams K, Wright J, Berkley-Patton J. Do coping styles mediate the relationship between substance use and educational attainment and antiretroviral adherence? AIDS Behav 2012; 16:2319-29. [PMID: 22673969 DOI: 10.1007/s10461-012-0222-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There is a substantial body of literature that demonstrates that substance use and lower educational attainment are associated with poorer antiretroviral (ART) adherence, however, the nature of these relationships are not well understood. The purpose of this study was to explore whether coping styles mediate the relationship between substance use and educational attainment and ART adherence in order to better understand how these variables relate to adherence. The sample consisted of 192 HIV-positive patients (mean age = 41 years; 75.5 % male, 46.9 % heterosexual; 52.6 % with a high school/GED education or less) who were on ART. Path analysis revealed that active and avoidant coping significantly mediated the relationship between drug use and ART adherence. No form of coping was found to mediate the relationship between either binge drinking or educational attainment and adherence. Findings suggest that a focus on coping skills should be included in any multimodal intervention to increase ART adherence among HIV-positive drug using patients.
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Affiliation(s)
- David A Martinez
- Department of Psychology, University of Missouri-Kansas City, 5030 Cherry St., Room 138, Kansas City, MO, 64110, USA.
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Utility of a partner communication scale and a personal meaning scale in newly diagnosed HIV-infected persons. J Assoc Nurses AIDS Care 2012; 24:126-34. [PMID: 22943981 DOI: 10.1016/j.jana.2012.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
No studies to our knowledge have examined the Lepore Social Constraint Scale or Fife Constructed Meaning Scale in recently diagnosed HIV-infected persons. Twenty-four participants in a prospective observational cohort completed the social-constraint measure, and 47 completed the constructed-meaning scale at either 3 or 9 months after diagnosis. Participants completed a 4-week visual analogue scale to assess adherence to antiretroviral therapy, and validated depression and self-efficacy scales. Spearman correlation coefficients compared measures. In cross-sectional analyses, participants with higher social-constraint scores had lower constructed meaning and adherence. Higher social constraint correlated negatively with self-efficacy and positively with depression. Higher constructed-meaning scores did not correlate with adherence but correlated positively with self-efficacy and negatively with depression. The quality of HIV-infected individuals' discussions of HIV with their partners and positive constructed meaning were associated with better mental health and could be targets for improving medication adherence.
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Tumwine C, Neema S, Wagner G. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study. RELIGIONS 2012; 3:817-832. [PMID: 24432189 PMCID: PMC3890424 DOI: 10.3390/rel3030817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy-ART) to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their "already healed" peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, "taking care of other illness", and reducing worries. When high religiosity among people living with HIV (PHAs) becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.
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Affiliation(s)
- Christopher Tumwine
- Infectious Diseases Institute, Makerere University, P.O. Box 22184, Kampala, Uganda
- Author to whom correspondence should be addressed;
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Glenn Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
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Lyimo RA, de Bruin M, van den Boogaard J, Hospers HJ, van der Ven A, Mushi D. Determinants of antiretroviral therapy adherence in northern Tanzania: a comprehensive picture from the patient perspective. BMC Public Health 2012; 12:716. [PMID: 22935331 PMCID: PMC3488585 DOI: 10.1186/1471-2458-12-716] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 08/20/2012] [Indexed: 11/23/2022] Open
Abstract
Background To design effective, tailored interventions to support antiretroviral therapy (ART) adherence, a thorough understanding of the barriers and facilitators of ART adherence is required. Factors at the individual and interpersonal level, ART treatment characteristics and health care factors have been proposed as important adherence determinants. Methods To identify the most relevant determinants of adherence in northern Tanzania, in-depth interviews were carried out with 61 treatment-experienced patients from four different clinics. The interviews were ad-verbatim transcribed and recurrent themes were coded. Results Coding results showed that the majority of patients had basic understanding of adherence, but also revealed misconceptions about taking medication after alcohol use. Adherence motivating beliefs were the perception of improved health and the desire to live like others, as well as the desire to be a good parent. A de-motivating belief was that stopping ART after being prayed for was an act of faith. Facilitators of adherence were support from friends and family, and assistance of home based care (HBC) providers. Important barriers to ART adherence were the use of alcohol, unavailability of food, stigma and disclosure concerns, and the clinics dispensing too few pills. Strategies recommended by the patients to improve adherence included better Care and Treatment Centre (CTC) services, recruitment of patients to become Home Based Care ( HBC) providers, and addressing the problem of stigma through education. Conclusion This study underscores the importance of designing tailored, patient-centered adherence interventions to address challenges at the patient, family, community and health care level.
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Affiliation(s)
- Ramsey A Lyimo
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, P,O,Box 2236, Moshi, Tanzania.
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Kagee A, Nel A. Assessing the association between self-report items for HIV pill adherence and biological measures. AIDS Care 2012; 24:1448-52. [PMID: 22670758 DOI: 10.1080/09540121.2012.687816] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Sub-optimal pill adherence to antiretroviral treatment among HIV-infected persons may have serious consequences, including a decline in health status, eventually leading to death. We developed an instrument to assess self-reported pill adherence to antiretroviral therapy (ART) among patients attending a public health clinic in South Africa. The instrument, based on previously published guidelines, consisted of five questions and a visual analogue scale assessing pill adherence behaviour and was administered to 101 patients living with HIV who commenced ART at least six months prior to data collection. The scale showed fair but not excellent internal consistency (alpha reliability=0.63). Participants reported generally high levels of pill adherence. One question on the scale was able to distinguish between a detectable and a lower than detectable viral load (p<0.01). Yet, the combined items did not predict biologically measured adherence. Despite good comprehensibility of items, the study may have been vulnerable to recall and social desirability bias and was conducted only among clinic attenders rather than those with varied levels of clinic attendance, which is potentially a matter for further study.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, University of Stellenbosch, Cape Town, 7602, South Africa.
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Grossoehme DH, Opipari-Arrigan L, VanDyke R, Thurmond S, Seid M. Relationship of adherence determinants and parental spirituality in cystic fibrosis. Pediatr Pulmonol 2012; 47:558-66. [PMID: 22170872 PMCID: PMC4646606 DOI: 10.1002/ppul.21614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 08/28/2011] [Indexed: 11/11/2022]
Abstract
The course of cystic fibrosis (CF) progression in children is affected by parent adherence to treatment plans. The Theory of Reasoned Action (TRA) posits that intentions are the best behavioral predictors and that intentions reasonably follow from beliefs ("determinants"). Determinants are affected by multiple "background factors," including spirituality. This study's purpose was to understand whether two parental adherence determinants (attitude towards treatment and self-efficacy) were associated with spirituality (religious coping and sanctification of the body). We hypothesized that parents' attitudes toward treatment adherence are associated with these spiritual constructs. A convenience sample of parents of children with CF aged 3-12 years (n = 28) participated by completing surveys of adherence and spirituality during a regular outpatient clinic visit. Type and degree of religious coping was examined using principal component analysis. Adherence measures were compared based on religious coping styles and sanctification of the body using unpaired t-tests. Collaborative religious coping was associated with higher self-efficacy for completing airway clearance (M = 1070.8; SD = 35.8; P = 0.012), for completing aerosolized medication administration (M = 1077.1; SD = 37.4; P = 0.018), and for attitude towards treatment utility (M = 38.8; SD = 2.36; P = 0.038). Parents who attributed sacred qualities to their child's body (e.g., "blessed" or "miraculous") had higher mean scores for self-efficacy (airway clearance, M = 1058.6; SD = 37.7; P = 0.023; aerosols M = 1070.8; SD = 41.6; P = 0.020). Parents for whom God was manifested in their child's body (e.g., "My child's body is created in God's image") had higher mean scores for self-efficacy for airway clearance (M = 1056.4; SD = 59.0; P = 0.039), aerosolized medications (M = 1068.8; SD = 42.6; P = 0.033) and treatment utility (M = 38.8; SD = 2.4; P = 0.025). Spiritual constructs show promising significance and are currently undervalued in chronic disease management.
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Affiliation(s)
- Daniel H Grossoehme
- Division of Pulmonary Medicine and Department of Pastoral Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Wagner GJ, Goggin K, Remien RH, Rosen MI, Simoni J, Bangsberg DR, Liu H. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med 2012; 42:352-60. [PMID: 21818528 DOI: 10.1007/s12160-011-9295-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Depression consistently predicts nonadherence to human immunodeficiency virus antiretroviral therapy, but which aspects of depression are most influential are unknown. Such knowledge could inform assessments of adherence readiness and the type of depression treatment to utilize. PURPOSE We examined how depression severity, symptom type, and change over time relate to adherence. METHODS Microelectronic adherence and self-reported depression data from 1,374 participants across merged studies were examined with cross-sectional and longitudinal analyses. Depression variables included a continuous measure, categorical measure of severity, cognitive and vegetative subscales, and individual symptoms. RESULTS At baseline, mean adherence was 69%, and 25% had mild/moderate and 18% had severe depression. In cross-sectional multivariate analyses, continuous depression, cognitive depressive symptoms, and severe depression were associated with lower adherence. In longitudinal analysis, reductions in both continuous and categorical depression predicted increased adherence. CONCLUSIONS The relationship between global continuous depression and nonadherence was statistically significant, but relatively weak compared to that of cognitive depressive symptoms and severe depression, which appear to pose strong challenges to adherence and call for the need for early detection and treatment of depression.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, Health Unit, Santa Monica, CA 90407, USA.
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