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Saputra R, Waluyo A, Edison C. The Relationship between Distress Tolerance and Spiritual Well-Being towards ARV Therapy Adherence in People Living with HIV/AIDS. Healthcare (Basel) 2024; 12:839. [PMID: 38667601 PMCID: PMC11050109 DOI: 10.3390/healthcare12080839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
A crucial factor in the success of treatment for patients with Human Immunodeficiency Virus (HIV) is adherence to antiretroviral (ARV) therapy among People Living with HIV/AIDS (PLWHA). Adherence issues remain a persisting problem with multifaceted causes. There are many studies on variables related to ARV therapy adherence, but no study has been found on spiritual well-being and distress tolerance in ARV therapy adherence. This study aims to determine the relationship between distress tolerance and spiritual well-being on adherence to ARV therapy in PLWHA. This research used a quantitative approach with a cross-sectional design. The sample collection process followed a consecutive sampling technique, with data gathered from 129 participants at the South Lampung Regional General Hospital located in Indonesia. Data collection was conducted using three questionnaires administered by the interviewer, which assessed distress tolerance using the Miller-Smith Rating Scale For Stress Tolerance (MSRS-ST), evaluated spiritual Well-Being using the Spiritual Well-Being Scale (SWBS), and gauged ARV therapy adherence using the Medication Adherence Rating Scale (MARS). Data analysis using a simple logistic regression with a 95% confidence interval (CI) showed a significant relationship between distress tolerance (p-value 0.002) and spiritual well-being (p-value 0.036) towards ARV therapy adherence in PLWHA. The results of multiple logistic regression yielded distress tolerance as the most dominant and influential variable in this research. Distress tolerance and spiritual well-being impact adherence to ARV therapy in PLWHA. Suggestions for healthcare services should consider these factors to decrease the risk of non-adherence to therapy and inadvertently heighten mortality risk.
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Affiliation(s)
| | - Agung Waluyo
- Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia; (R.S.); (C.E.)
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Azia IN, Nyembezi A, Carelse S, Mukumbang FC. Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review. BMC Public Health 2023; 23:1768. [PMID: 37697279 PMCID: PMC10494378 DOI: 10.1186/s12889-023-16616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Optimum adherence to antiretroviral therapy (ART) is crucial in managing HIV. However, some people's religious beliefs can influence how they deal with HIV and the psychosocial factors influencing their adherence to ART, such as disclosure, acceptance of HIV status, belief in ART, and depression. In sub-Saharan Africa (SSA), the role of religious beliefs in ART adherence is underexplored. We aimed to identify and conceptualize the literature on religious beliefs concerning ART adherence among Pentecostal Christians living with HIV in SSA. METHODS We conducted a scoping review of the literature on religious beliefs and ART adherence. We searched papers from PubMed, Web of Science, Medline, Sabinet, Academic Search Complete, CINAHL Plus, Health Source/Nursing Academic, Scopus, and Google Scholar and published papers from conference proceedings and dissertations. Data were extracted according to a predetermined population, concept, context framework, and eligibility criteria for selecting or rejecting studies. We used a narrative synthesis to summarize the data on evidence and the impact of religious beliefs on ART adherence. RESULTS Seven papers published between January 2010 and February 2022 met the inclusion criteria. Nineteen aspects of religious beliefs were identified as negatively influencing ART adherence, while eight aspects facilitated optimal adherence. "Being saved" or "born again" enhanced coping strategies for optimal adherence through actions such as less alcohol use, fidelity to a sexual partner(s), disclosure, acceptance of HIV status, reduced depression, and facilitated PLHIV to access social support from church members or other institutions. CONCLUSION Religious beliefs are integral to Pentecostal Christians living with HIV and affect their adherence to ART. While some Pentecostal Christians living with HIV on ART use their religious beliefs and practices to access psychosocial support from other church members or organizations and achieve good clinical outcomes, others apply their religious beliefs and practices differently and compromise their commitments to taking ART as prescribed, thus experiencing poor viral suppression and clinical outcomes. However, more research is required to understand and theorize how religious beliefs impact ART adherence among Pentecostals living with HIV to inform guidelines for practitioners.
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Affiliation(s)
- Ivo Nchendia Azia
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
| | - Shernaaz Carelse
- Department of Social Works, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C. Mukumbang
- School of Public Health, University of the Western Cape, Robert Sobukwe Road Private Bag X17, Cape Town, 7535 Bellville South Africa
- Department of Global Health, University of Washington, Seattle, USA
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Azia IN, Carelse S, Nyembezi A, Mukumbang FC. Role of religious beliefs in adherence to antiretroviral therapy in the Cape Town metropole: a study protocol. BMJ Open 2022; 12:e062464. [PMID: 36104142 PMCID: PMC9476115 DOI: 10.1136/bmjopen-2022-062464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There are presently over four million people living with HIV (PLHIV) in the South African national antiretroviral therapy (ART) programme. However, some ART programmes are battling poor ART adherence emanating from patient-related factors, including their religious beliefs. In this paper, we outline a study protocol to understand the adherence behaviours of Pentecostal Christians living with HIV to ART and to develop guidelines that can be used to strengthen ART adherence. METHODS AND ANALYSIS We propose an exploratory multimethod research design. In phase 1, a scoping review will be conducted. The data captured in this phase will be put into charting forms, analysed qualitatively, and then collated and summarised to hypothesise the relationship between religious beliefs and ART adherence. In phase 2, an explanatory qualitative approach will be used. Semistructured interviews will be conducted with purposefully selected religious leaders, Pentecostal Christians living with HIV who are not adhering to ART and healthcare workers delivering ART at selected healthcare facilities in the Milnerton subhealth district. The qualitative data obtained in this phase will be transcribed verbatim and analysed thematically using the ATLAS.ti V.8 software program towards strengthening the hypothesised relationship between religious beliefs and ART adherence. In phase 3, intervention mapping and nominal group techniques will be applied with purposefully selected stakeholders to develop guidelines to strengthen ART adherence among PLHIV. ETHICS AND DISSEMINATION Phase 1 of the study will not require ethics approval. Ethics approval for phases 2 and 3 has been received from the University of the Western Cape Biomedical Research and Ethics Committee and the Western Cape Department of Health. Informed consent forms will be obtained from all participants at the different phases of the study. The study findings will be disseminated through publications in scientific journals, presentations at conferences and workshops aimed at improving ART adherence.
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Affiliation(s)
- Ivo Nchendia Azia
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Shernaaz Carelse
- Department of Social Works, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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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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Loue S, Bajunirwe F. EVANGELICALISM IN UGANDA: IMPLICATIONS FOR PUBLIC HEALTH AND BIOETHICS. JOURNAL OF INTERCULTURAL MANAGEMENT AND ETHICS 2021; 4:33-49. [PMID: 38550302 PMCID: PMC10976434 DOI: 10.35478/jime.2021.2.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Considered attention is needed to the interplay between evangelical and charismatic religions and legislation in Uganda and their implications for public health, bioethics, and medical education. This manuscript examines the growth of the evangelical and charismatic movements in Uganda during the past several decades, concurrent trends in the formulation and implementation of law and public policy, and implications for the prevention and treatment of sexually transmitted infections, family violence, physician-patient communication, and medical and health education. The article concludes with suggested strategies to address the adverse consequences stemming from the interjection of religious perspectives into the domains of public health, clinical care, and health education.
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Affiliation(s)
- Sana Loue
- Case Western Reserve University School of Medicine, Cleveland, Ohio USA
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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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Mutambara J, Sodi T, Mtemeri J, Makomo M. Harmonizing religion and health: an exploration of religious reasons for defaulting ARVs among people living with HIV and AIDS in Gweru, Zimbabwe. AIDS Care 2020; 33:383-388. [PMID: 32030992 DOI: 10.1080/09540121.2020.1724255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There has been a proliferation of faith healing organizations in Zimbabwe in the past decade. These organizations have been attracting many people especially those with chronic conditions as their leaders claim to have spiritual powers to heal illnesses. This has led to people with chronic conditions opting for spiritual healing over medical methods thereby defaulting ARVs. This qualitative study sought to explore religious related reasons that have led to defaulting Antiretroviral drugs (ARVs) among People Living with HIV and AIDS in Gweru, Zimbabwe (PLWHIV). Fifteen participants who at one point defaulted medications, six counselors and four religious leaders were interviewed. Content analysis was used to analyze data. Themes obtained revealed that PLWHIV defaulted medications because - they believed in faith healing, alternative medicines, perceived spirituality as the main cause of HIV and AIDS and that they had an allegiance to church values. The study recommends the need to provide HIV and AIDS education to leaders of religious organizations so as to harmonize religion and HIV and AIDS treatment.
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Affiliation(s)
- Julia Mutambara
- Department of Psychiatry, Midlands State University, Gweru, Zimbabwe
| | - Tholene Sodi
- Psychology Department, University of Limpopo, Mankweng, South Africa
| | - Joefrey Mtemeri
- Psychology Department, Great Zimbabwe University, Masvingo, Zimbabwe
| | - Marcia Makomo
- Psychology Departrment, Midlands State University, Gweru, Zimbabwe
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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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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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10
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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: 103] [Impact Index Per Article: 17.2] [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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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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12
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Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health 2016; 1:e000125. [PMID: 28588979 PMCID: PMC5321378 DOI: 10.1136/bmjgh-2016-000125] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults. DESIGN Systematic review of adherence to ART in SSA from January 2002 to October 2014. METHODS A systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants. RESULTS Of the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence. CONCLUSIONS The sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.
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Affiliation(s)
- Tessa Heestermans
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susan C Aitken
- Ndlovu Research Consortium, Elandsdoorn, South Africa
- Department of Medical Microbiology, University Medical Centre Utrecht, The Netherlands
| | - Sigrid C Vervoort
- University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Osingada CP, Okuga M, Nabirye RC, Sewankambo NK, Nakanjako D. Prevalence, barriers and factors associated with parental disclosure of their HIV positive status to children: a cross-sectional study in an urban clinic in Kampala, Uganda. BMC Public Health 2016; 16:547. [PMID: 27401865 PMCID: PMC4940877 DOI: 10.1186/s12889-016-3235-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of parental HIV status is associated with a number of positive outcomes such as improved adherence to clinic appointments, lower levels of parental anxiety and depression, and mutual emotional support between parents and their children. Very few studies in low-resource settings have addressed the issues of parental disclosure of their HIV status to their children. METHODS A cross-sectional study was conducted among adult parents attending HIV/AIDS prevention, care and treatment clinic at Makerere University Infectious Diseases Institute (IDI), Kampala, Uganda. Participants were interviewed using the Parent Disclosure Interview (PDI) questionnaire which is a standard tool developed specifically for HIV infected parents. Data were analyzed using STATA version 13.1. RESULTS Of 344 participants, only 37 % had told at least one of their children that they were HIV positive. Barriers to disclosure were fear that children may tell other people about the parent's HIV status, desire not to worry or upset children and perceptions that children may not understand. Age of the parent, religion and having someone committed to care of the children were positively associated with parental disclosure of their HIV positives status. Attainment of tertiary level of education was negatively associated with parental disclosure of their HIV status. CONCLUSIONS Parental disclosure of a positive HIVstatus to their children is still low in urban Kampala. There is therefore need to develop locally relevant interventions so as to increase rates of parental disclosure of a positive HIV status to their children and thus promote open and honest discussions about HIV/AIDS at family level.
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Affiliation(s)
- Charles Peter Osingada
- Department of Nursing, Makerere University College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Monica Okuga
- Department of Health Policy planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, Makerere University College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Nelson Kaulukusi Sewankambo
- Department of Internal Medicine, School of Medicine, Makerere College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Internal Medicine, School of Medicine, Makerere College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea. PLoS One 2015; 10:e0134918. [PMID: 26244516 PMCID: PMC4526685 DOI: 10.1371/journal.pone.0134918] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/15/2015] [Indexed: 11/24/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.
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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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