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Luthuli MQ, John-Langba J. The Moderating Role of HIV Stigma on the Relationship between Perceived Social Support and Antiretroviral Therapy Adherence Self-Efficacy among Adult PLHIV in South Africa. J Int Assoc Provid AIDS Care 2024; 23:23259582241228743. [PMID: 38594925 DOI: 10.1177/23259582241228743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND People living with human immune deficiency virus (PLHIV) grapple with distinct challenges, including HIV stigma which affects their antiretroviral therapy (ART) adherence self-efficacy. This study investigates the interaction of HIV stigma and perceived social support on ART adherence self-efficacy among adult PLHIV in South Africa. METHODS This study utilized a cross-sectional design that involved 201 participants selected using time location sampling at a tertiary health facility in Durban. RESULTS HIV stigma was significantly and negatively associated with self-efficacy (β = -7.860, t = -4.654, p = .001), with variations across different stigma levels (β = -5.844, t = -4.003, p = .001). Social support was significantly and positively associated with self-efficacy at lower HIV stigma levels (β = 7.440, t = 3.887, p = .001), in contrast to higher levels (β = -2.825, t = 1.400, p = .163). CONCLUSION Social support significantly influences ART adherence self-efficacy, particularly at lower levels of HIV stigma, but the effect of support weakens as stigma intensifies.
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Affiliation(s)
- Muziwandile Qiniso Luthuli
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Johannes John-Langba
- Discipline of Social Work, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
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Wang P, Xiong J, Zheng J, Chai C, Wang Y. Perceived social support and depression among people living with HIV in China: roles of stigma and adherence self-efficacy. BMC Psychiatry 2023; 23:544. [PMID: 37495961 PMCID: PMC10373273 DOI: 10.1186/s12888-023-04997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) are a high-risk group for depression. In particular, the prevalence and burden of depression is higher and more severe among PLHIV in developing and less-developed countries. There is evidence that perceived social support has a positive impact on reducing the occurrence of depression, and high stigma and low adherence self-efficacy are barriers to the effectiveness of social support for depressed PLHIV. However, how these risks affect the effect of social support on depression still needs further identification. METHODS Between 2017 and 2018, a total of 1139 Chinese PLHIV (74.36% male, mean age = 43.91 years) from three provinces (Shanghai, Zhejiang and Henan) in China were enrolled in the study. Data were analyzed by multiple regression, mediation model, and moderation model. RESULTS A total of 43.99% of PLHIV had mild to severe depression. There was a significant negative association between perceived social support and depression (B = -0.049, P < 0.05). Stigma and adherence self-efficacy played a chain mediating role (B = -0.058, 95% CI: -0.078 ~ 0.039) and a moderating role in the effect of perceived social support on depression (stigma: B = -0.003, P < 0.05; adherence self-efficacy: B = 0.004, P < 0.05). CONCLUSION Stigma and adherence self-efficacy indirectly predicted depression, and perceived social support was more effective in reducing depression among PLHIV with high stigma or low adherence self-efficacy. Enhancing multiple social support resources for PLHIV may reduce their risk of depression. Moreover, the need for social support is greater for those with high stigma or low adherence self-efficacy.
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Affiliation(s)
- Pengfei Wang
- School of Public Health, Fudan University, No. 130, Dong'an Road, Shanghai, 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 130, Dong'an Road, Shanghai, 200032, China
| | - Jianjing Xiong
- Jing'an District Center for Disease Control and Prevention, No. 195, Yonghe Road, Shanghai, 200072, China
| | - Jinlei Zheng
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Hangzhou, 310021, Zhejiang, China
| | - Chengliang Chai
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Hangzhou, 310021, Zhejiang, China.
| | - Ying Wang
- School of Public Health, Fudan University, No. 130, Dong'an Road, Shanghai, 200032, China.
- NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 130, Dong'an Road, Shanghai, 200032, China.
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Yousaf I, Haqqani S. HIV Treatment Adherence Self-efficacy Scale for Pakistani HIV/AIDS patients: Translation and psychometric evaluation. Appl Nurs Res 2022; 66:151606. [DOI: 10.1016/j.apnr.2022.151606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
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Gitahi-Kamau N, Wahome S, Memiah P, Bukusi EA. The Role of Self-Efficacy in HIV treatment Adherence and its interaction with psychosocial factors among HIV Positive Adolescents in Transition to Adult Care in Kenya. VULNERABLE CHILDREN AND YOUTH STUDIES 2021; 17:308-319. [PMID: 36439942 PMCID: PMC9698266 DOI: 10.1080/17450128.2021.1954736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
Adolescents and young adults (15-24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16-19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p<0.001 and p=0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99-24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.
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Affiliation(s)
- Nyawira Gitahi-Kamau
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samuel Wahome
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore Maryland
| | - Elizabeth A Bukusi
- Institute of Tropical Medicine and Infectious Disease. Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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HIV Treatment Initiation and Retention Among Individuals Initiated on Injectable Opioid Agonist Therapy for Severe Opioid Use Disorder: A Case Series. J Addict Med 2021; 14:437-440. [PMID: 32011407 DOI: 10.1097/adm.0000000000000609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Injectable opioid agonist therapy (iOAT) has previously been demonstrated to be an effective treatment option for individuals with a severe opioid use disorder (OUD) who have been unsuccessful on first line therapy (eg, buprenorphine/naloxone or methadone). Many individuals with severe OUD may also have HIV infection. Despite this, no literature currently exists examining the relationship between antiretroviral therapy (ART) initiation and adherence following iOAT initiation in the outpatient setting. METHODS Retrospective case series (n = 3) of HIV-infected individuals with a severe OUD who were refractory to oral opioid agonist treatment and were started on iOAT in a community setting in Vancouver, Canada. Outcomes of interest included: (1) iOAT induction and maintenance dosing schedules; (2) ART adherence demonstrated by change in HIV viral load. RESULTS All 3 patients initiated and successfully reached iOAT maintenance doses with significant reduction in illicit opioid use. Stable iOAT was associated with increased ART initiation and adherence, and decreased HIV viral loads. Conversely, poor retention or discontinuation of iOAT was associated with reduced adherence to ART and in 1 patient, increased HIV viral loads. CONCLUSIONS The individual cases presented suggest that among individuals with severe OUD and HIV infection, iOAT may improve HIV treatment uptake and retention in care.
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Felsher M, Ziegler E, Amico KR, Carrico A, Coleman J, Roth AM. "PrEP just isn't my priority": Adherence challenges among women who inject drugs participating in a pre-exposure prophylaxis (PrEP) demonstration project in Philadelphia, PA USA. Soc Sci Med 2021; 275:113809. [PMID: 33735778 DOI: 10.1016/j.socscimed.2021.113809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has the ability to curb HIV transmission among women if they are highly adherent (e.g. 6/7 weekly doses). In a recent PrEP demonstration project with 95 women who inject drugs (WWID) in Philadelphia, PA, USA, PrEP uptake was high but adherence was low. This qualitative study draws upon the Behavioral Model for Vulnerable Populations (BMVP) to describe how the context of 23 WWID's lives challenged PrEP adherence using narrative data from in-depth interviews. Content analysis suggests that women's need to organize their day around predisposing survival needs made it difficult to prioritize PrEP. Adherence was further challenged by dis-enabling structural forces such as entry into institutions that do not provide PrEP (e.g., drug treatment and correctional facilities) and medication diversion to illicit marketplaces. Overtime, women's perceived need for PrEP was dynamic: in periods they characterized as risky, women considered PrEP highly beneficial and described enhanced motivation to adhere. In periods of low perceived risk, women were less committed to continuing daily PrEP in the context of their competing survival needs. In sum, WWID faced challenges to PrEP adherence that correspond to all of the BMVP domains. To optimize PrEP for WWID, multi-level programs are needed that address the determinants that both increase HIV susceptibility and undermine adherence.
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Affiliation(s)
- Marisa Felsher
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Eliza Ziegler
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - K Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Jennie Coleman
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA, 19134, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
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HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. J Acquir Immune Defic Syndr 2019; 80:166-173. [PMID: 30383588 DOI: 10.1097/qai.0000000000001891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART); yet, no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment, including explanatory pathways using mediation analysis. SETTING Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS Participants were assessed using an audio computer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates and PROCESS macro to test the explanatory pathway (ie, mediational effect) for optimal ART adherence. RESULTS Among 121 participants, almost 40% reported suboptimal adherence to ART. Optimal ART adherence was significantly associated with being virally suppressed [adjusted odds ratio (aOR) = 6.470, P = 0.038], higher motivation to adhere to ART (aOR = 1.171, P = 0.011), and lower anticipated HIV-related stigma (aOR = 0.384, P = 0.015). Furthermore, results revealed an indirect effect of motivation on the relationship between HIV stigma and ART adherence (effect = -0.121, P = 0.043), thus supporting the mediation effect. CONCLUSIONS Our findings underscore the complexities surrounding ART adherence, even in patients on methadone maintenance treatment. These findings provide insights on how to more effectively intervene to optimize HIV treatment outcomes, including HIV treatment-as-prevention initiatives, in methadone-maintained patients.
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Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART). Addict Behav 2018; 85:88-93. [PMID: 29879611 DOI: 10.1016/j.addbeh.2018.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) is associated with improved virologic outcomes, yet no studies have explored factors associated with viral suppression in HIV-infected patients on MMT. Given the critical role of sustained viral suppression in maximizing benefits of antiretroviral therapy (ART), we sought to assess factors associated with viral suppression in patients stabilized on MMT. METHODS A sample of 133 HIV-infected, methadone-maintained patients who reported HIV-risk behaviors were assessed using an audio-computer assisted self-interview (ACASI). Multivariable logistic regression was used to identify significant correlates of viral suppression. RESULTS Among all participants, self-reported HIV risk behaviors were highly prevalent and over 80% had achieved viral suppression. Independent correlates of viral suppression were: having optimal adherence to ART (aOR = 4.883, p = .009), high CD4 count (aOR = 2.483, p = .045), and ongoing injection drug use (aOR = 0.081, p = .036). Furthermore, results revealed a significant interaction effect that involved optimal ART adherence and injection of drug use on viral suppression (aOR = 2.953, p = .029). CONCLUSION Overall, our findings highlight unaddressed HIV-related treatment challenges faced by certain group of methadone-maintained patients. These findings have significant implications for the HIV treatment as prevention efforts and, thus, indicate the need for comprehensive efforts to promote viral suppression in this risk population.
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Grabovac I, Meilinger M, Schalk H, Leichsenring B, Dorner TE. Prevalence and Associations of Illicit Drug and Polydrug Use in People Living with HIV in Vienna. Sci Rep 2018; 8:8046. [PMID: 29795303 PMCID: PMC5966416 DOI: 10.1038/s41598-018-26413-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023] Open
Abstract
We aimed to determine the prevalence of drug and polydrug use in people living with HIV in Austria for the first time for which a two center cross-sectional study was performed. Participants were recruited from consecutive patients during their regularly scheduled visits. In total 438 participants were included in the analysis. For this study we used paper-pencil and online-based questionnaires. The prevalence of illicit drug use was 60.5%; with cannabis use at 31.5%, nitrates at 31.5%, sildenafil/tadalafil at 24% and cocaine at 14%, being the most used substances. Use of more than one substance (polydrug) in drug users was 69.4% or 42.0% in the total study population. Younger age, male gender, and living in an urban area were associated with drug use. Moreover, drug use during clubbing and sex, HIV therapy non-adherence and younger age were associated with polydrug use. Drug users reported condomless sex in 42.4% and performing sexual acts they would not do sober in 44.1%. Results indicate a high prevalence of illicit drug use in PLWHIV in Austria. New research focusing on illicit drug use in PLWHIV should focus on the use of substances during sex and surrounding practices.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Michael Meilinger
- 2nd Department of Respiratory and Critical Care, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
| | - Horst Schalk
- "Schalk - Pichler" Group-practice, Zimmermannplatz 1, 1090, Vienna, Austria
| | | | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
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