Social and Religious Support on Treatment Adherence Among HIV/AIDS Patients by Race/Ethnicity

Abstract

Using data from the second follow-up of the HIV Cost and Services Utilization Study (HCSUS), we investigated the influence of social and religious support variables on treatment adherence for Whites, African American and Hispanic HIV patients. Study results show differential effects of social, religious support and background variables on treatment adherence. In general, for Whites, background variables such as educational levels and age were found to be significant variables affecting treatment adherence, in addition to some religious support variables. On the other hand, for African Americans and Hispanics, religious and social support variables were influential. Results also suggest that strategies to improve treatment adherence may vary for different race/ethnic groups. The study highlights the importance of working with and involving religious organizations in an effort to increase adherence and support to HIV-infected members, particularly among African Americans and Hispanic communities.     

Predictors of Medication Adherence Among HIV/AIDS Clients

Abstract

Lack of adherence to medication regimens among people living with HIV/AIDS can lead to new drug resistant strains of the virus as well as continuing spread of the disease. Due to suboptimal adherence, the prevalence of these resistant strains continues to increase, posing a serious public health risk. Adherence to the various medications must be 95–100% complete in order to be considered adequate; however, 57% to 77% of patients fail to reach this level of adherence. Treatment of HIV-infected persons with highly active antiretroviral therapy (HAART) is often challenging due to the presence of factors that can affect adherence, such as complex regimens, total pill burden, and food dosing restrictions. This study seeks to identify factors that predict medication adherence among HIV positive adults. Independent variables included adherence information, adherence motivation, adherence behavioral skills, demographic factors and environmental factors. Results from the exploratory study using a convenience sample of patients lend support to Fisher's Information-Motivation-Behavior model of HIV prevention. Implications for research and practice are discussed.     

Informal Social Support for HIV Medical Care

Abstract

The purpose of this paper is to explore the relationship of availability of HIV-related information and emotional support necessary to obtaining appropriate medical care. Multivariate models control for use of professional case management, mental health services, and drug treatment services. Study data were obtained from the first two rounds of interviews from the New York City Community Health Advisory and Information Network (CHAIN). Household information support and professional ancillary services were significantly associated with entry into appropriate medical care. Among participants in appropriate care at the baseline, only professional services were significantly associated with continuity of care.     

Literacy,Social Stigma,and HIV Medication Adherence

BACKGROUND  Prior studies have linked limited literacy to poorer HIV medication adherence, although the precise causal pathways of this relationship have only been initially investigated. OBJECTIVE  To examine whether social stigma is a possible mediator to the relationship between literacy and self-reported HIV medication adherence. DESIGN  Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while stigma was measured using items taken from the Patient Medication Adherence Questionnaire (PMAQ). PARTICIPANTS  Two hundred and four consecutive patients participated. RESULTS  Approximately one-third of the patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal (7th–8th grade) or low (≤ 6th grade) literacy. In multivariate analyses, patients with low literacy were 3.3 times more likely to be non-adherent to antiretroviral regimens (95% CI 1.3–8.7; p < 0.001). Perceived social stigma was found to mediate the relationship between literacy and medication adherence (AOR 3.1, 95% CI 1.3–7.7). CONCLUSIONS  While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, perceived social stigma mediated this relationship. Low literacy HIV intervention strategies may also need to incorporate more comprehensive psychosocial approaches to overcome stigma barriers.     

Training Substance Abuse Counselors About HIV Medication Adherence

Abstract

High levels of medication adherence are crucial to the success of HIV treatment. Consequently, substance abuse counselors (SACs), social service and other care providers can best support their HIV positive clients when they understand adherence and related interventions. This paper describes a training program that was designed to increase counselor knowledge of HIV medications, adherence strategies and enhance counseling skills specific to HIV adherence. For substance abuse counselors the training needs included: better understanding of medication interactions, relapse, recovery, and interdisciplinary communication. Thirty-six SACs from three agencies completed the 11/2-day training, which included lecture discussions, case discussion and interactive client case simulations. Success in accomplishing training objectives was evaluated at three points: preintervention training, post-intervention, and six month follow-up to determine changes in participants' knowledge, attitudes and behaviors related to adherence counseling. Three case scenarios measuring counselor comfort levels indicated SACs felt significantly more comfortable discussing relapse and medication issues with their HIV affected clients than they would in discussing medication issues with the client's physician. However, they felt slightly more comfortable about physician discussions after training. Open-ended comments by SACs at six-month follow-up provided insights into recovery issues their clients faced. The findings suggest ways medication adherence could fit the reality of serving clients with co-occurring HIV and substance use to better meet their health and support needs.     

Medication and Behavioral Adherence Among HIV+ Older Adults

The purpose of this investigation was to explore HIV medication adherence among older adults. In Study 1, 44 HIV+ adults were recruited from the University of Pennsylvania Center for AIDS Research and interviewed about their health behaviors, including medication adherence. In Study 2, 40 HIV+ adults were surveyed about their communication with their physician and HIV medication and behavioral recommendations. Both studies found that a considerable percentage of participants were not completely adherent to their HIV medications. Furthermore, the majority of participants reported good communication with their physician. The findings of these studies have implications for intervention efforts aimed at increasing adherence to both medications and recommended behaviors among HIV+ older adults.     

HIV Treatment Adherence Research and Intervention

Abstract

Maximizing treatment adherence is essential for optimizing clinical outcomes among HIV/AIDS patients. A decade after the introduction of combination antiretroviral therapy (ART), numerous achievements and continued challenges are evident within research on HIV treatment adherence. In this paper, we illustrate some key themes within current treatment adherence research by highlighting presentations from a recent conference focused on this topic (the 2006 NIMH/IAPAC International Conference on HIV Treatment Adherence). We then discuss several ongoing challenges confronting the field, and suggest that multidisciplinary research will be essential for overcoming these challenges and strengthening our efforts to improve and sustain adherence to HIV treatment.     

Social support and mental health among adults prior to HIV counseling and testing in Durban,South Africa

Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study’s Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18; p < 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing.     

Social Perceptions of HIV/AIDS among the Wayuu of Colombia

Understanding how Indigenous populations perceive HIV/AIDS is of high relevance for the implementation of culturally appropriate interventions. The study analyzed the ways in which Indigenous Wayuu communities of Colombia socially perceive and respond to HIV/AIDS from their sociocultural realities and their knowledge of the illness. It analyzed qualitative data from 9 focus groups and 29 semi-structured interviews. The Wayuu think of HIV/AIDS as “the illness”, that it is incurable, fatal, transmitted from alijunas (non Wayuu), and beyond their understanding. They seem to perceive HIV/AIDS similarly to the ways Western societies perceived unknown or misunderstood epidemics in the past.     

Social Support Among HIV Positive Injection Drug Users: Implications to Integrated Intervention for HIV Positives

The study compared social support networks of HIV seropositive versus seronegative injection drug users (IDUs). Participants were 635 low income African Americans; 47% were HIV seropositive (of whom 17% had AIDS), 45% female, and 45% current drug users. A social network methodology elicited structural, functional, and relational network components. After controlling for confounders, HIV seropositive compared with HIV seronegative IDUs had larger support networks, including more females, kin and sources of instrumental assistance, and marginally more sources of emotional support, though they were less likely to have a sex partner. There was no difference between HIV status and number of active drug users in support networks. Results suggest that HIV seropositive IDUs had mobilized a range of network support but that they also relied on drug using social influences. Findings may have implications to the development of integrated HIV prevention and care intervention that builds on HIV seropositives natural support structures.     

An Observed Performance Test of Medication Management Ability in HIV: Relation to Neuropsychological Status and Medication Adherence Outcomes

Neuropsychological assessment may identify mild deficits in HIV-infected persons, but it is sometimes unclear if such deficits compromise functional competencies, such as the ability to adhere to complex medication regimens. We examined the relationship between neuropsychological status (NP), observed performance on a medication management test (MMT), and antiviral medication adherence as elicited in a 3-day recall measure. Two samples of HIV+ subjects (n = 20, n = 41) were used to develop and validate the MMT. An additional 57 HIV+ patients taking antivirals were assessed to examine NP, MMT, and adherence outcomes. NP performance was scored according to age- and education-based norms. Adherence was assessed by comparing reported medication use to medication insert information. Poorer performance on the MMT was associated with scores <–1 SD below norms in tests of memory (RAVLT), executive function (Odd Man Out), and psychomotor skill (Grooved Pegboard). Half the sample made >1 adherence error, as reported in the recall measure. Number of errors was related to both NP and MMT performance. Deficits identified in NP assessment and captured in an observed performance test of medication management are related to HIV medication adherence.     

Neurocognitive Aspects of Medication Adherence in HIV-Positive Injecting Drug Users

Cognitive deficits are associated with nonadherence to HIV medications. HIV-positive injecting drug users (IDUs) are at particular risk for nonadherence and cognitive barriers to adherence specific to this population should therefore be identified. The present study assessed the relation of three domains of cognitive functioning, executive functions, memory, and psychomotor speed, to self-reported antiretroviral adherence in a sample of HIV-positive IDUs. Depression, use of alcohol, heroin, cocaine/crack, or marijuana in the last week were also included in the models. Logistic regression analyses showed that only psychomotor slowing was significantly associated with nonadherence. Executive functions, memory, depression, and active alcohol and substance use were unrelated to adherence. No other studies to date have exclusively linked psychomotor slowing to nonadherence in HIV infection. Psychomotor slowing among our study sample was severe and suggests that when evident, such slowing may be a valuable determinant for antiretroviral adherence among IDUs.     

Adherence to Medication Treatment: A Qualitative Study of Facilitators and Barriers Among a Diverse Sample of HIV+ Men and Women in Four U.S. Cities

Most studies examining HIV antiretroviral medication treatment adherence involve quantitative surveys. Although these studies have identified factors associated with medical adherence, no single variable or combination of variables is sufficiently consistent to apply to any individual or group of people. Using qualitative methods, an ethnically diverse sample (N = 110) of HIV+ women, men who have sex with men, and male injecting drug users in four U.S. cities were interviewed in depth to elicit their experiences, perspectives, and life contexts regarding knowledge, attitudes, beliefs, and experiences with HIV medication adherence. Most described multiple influences on medication-taking behavior, describing adherence as a dynamic phenomenon that changes over time with their changing beliefs, attitudes, emotions, and daily and larger life events. Prevalent themes include ambivalence toward HIV medication and intentional nonadherence, usually to address physical side effects. Factors from different domains (e.g., cognitive, emotional, interpersonal) can have compensatory influences on behavioral outcomes. Findings are discussed in terms of social action theory, contributing to our theoretical understanding of the phenomenon of adherence.     

Gender,Drug Use,and Perceived Social Support Among HIV Positive Patients

We investigated the relationships among gender, drug use, and perceived social support in 176 HIV positive patients recruited with their informal caregivers in HIV clinics. Perceived caregiver support, emotional support, tangible support, and conflict were assessed. Current drug use was defined as heroin and/or cocaine use within 6 months prior to baseline. Gender was not significantly associated with any of the four outcomes. Current drug users reported significantly higher conflict in social relationships than nonusers, but was not significantly associated with the other three outcomes. However, significant heroin/cocaine use by gender interactions were observed; specifically, the negative associations between current drug use and perceived caregiver and emotional support were stronger among females than males. We concluded that recent heroin/cocaine use may be associated with dissatisfaction in perceived social support from most sources, with the strongest relationships amongst drug using females.     

Early Appointment Adherence Among Persons Living with HIV

Medical care for HIV disease may be most effective when medical surveillance and services are initiated early and consistently maintained over time. To benefit from continually improving HIV care regimens, persons living with HIV/AIDS must first adhere to their outpatient medical appointments. The purpose of this study was to examine psychosocial, illness, and demographic factors associated with appointment adherence problems early in HIV treatment. Results indicated that nonadherence to outpatient medical appointments was a significant problem. One hundred forty-four patients were followed for 6 months after their initial appointment at a public HIV clinic. One in five dropped out of treatment before completing their intake assessment (separate nurse and physician appointments). Men and individuals with lower levels of social support were most likely to drop out before seeing a physician. Emotional distress was not associated with early dropout, but elevated levels of anxiety and depression were found across the sample. Those still attending the clinic (n = 114) were then followed for 12 months after clinic enrollment. Overall, 35% of scheduled medical appointments were missed during this period. Higher baseline CD4 counts and injection drug use history were predictive of poor appointment adherence, but other demographic and psychosocial indices were not. These findings suggest increased research and early intervention efforts are needed to improve appointment adherence among persons living with HIV/AIDS.     

Social Support and Mood in Gay Caregivers of Men with AIDS

The objectives of the study were to compare different aspects of social support between caregiving partners of men with AIDS and partners of healthy men and to examine the association of social support with positive and negative mood. Data were collected in a longitudinal study of 244 gay male caregivers and 61 comparison gay male noncaregivers. Measures included perceived positive support; social conflict; sought support; amount, types, and sources of received support; relationships with family; and positive and negative mood. Cross-sectional analyses and changes between baseline and 2 years were examined. No significant differences were found between the caregivers and noncaregivers in most aspects of social support. Regression analyses showed (a) caregiver status was associated with positive and negative mood (caregivers reported lower positive mood and higher negative mood) at baseline, but not at 2 years; (b) perceived support was the only variable significantly associated with positive mood at baseline and at 2 years; and (c) social conflict (at both times) and perceived support, amount of received support, and having a family confidant (at one of the time periods) were associated with negative mood. The findings support the importance of distinguishing between perceptual and behavioral aspects of social support and their relation to both positive and negative mood.     

The Role of HIV Serostatus Disclosure in Antiretroviral Medication Adherence

This study examined the relationship between HIV serostatus disclosure and adherence to antiretroviral therapy (ART). The study was conducted with 215 HIV-seropositive patients who demonstrated poor adherence (<80%) and who were in serodiscordant relationships. Participants completed self-report measures regarding HIV serostatus disclosure and reasons for missing ART doses, as well as electronic monitoring of ART adherence (MEMS caps). Overall, 19% of the sample reported missing medication doses in the last two months due to concerns regarding serostatus disclosure. Participants who reported greater serostatus disclosure to others demonstrated higher rates of adherence, and this relationship remained after controlling for other explanatory variables. The relationship between disclosure and adherence was not mediated by practical support for adherence from others. Interventions to improve ART adherence should address the role of serostatus disclosure by providing patients with skills to maintain adherence in contexts of non-disclosure and to make informed choices regarding selective disclosure.     

Adherence to combination antiretroviral therapies in HIV patients of low health literacy

OBJECTIVE: To test the significance of health literacy relative to other predictors of adherence to treatment for HIV and AIDS. PARTICIPANTS: Community sample of HIV-seropositive men (n = 138) and women (n = 44) currently taking a triple-drug combination of antiretroviral therapies for HIV infection; 60% were ethnic minorities, and 73% had been diagnosed with AIDS. MEASUREMENTS: An adapted form of the Test of Health Literacy in Adults (TOFHLA), a comprehensive health and treatment interview that included 2-day recall of treatment adherence and reasons for nonadherence, and measures of substance abuse, social support, emotional distress, and attitudes toward primary care providers. MAIN RESULTS: Multiple logistic regression showed that education and health literacy were significant and independent predictors of 2-day treatment adherence after controlling for age, ethnicity, income, HIV symptoms, substance abuse, social support, emotional distress, and attitudes toward primary care providers. Persons of low literacy were more likely to miss treatment doses because of confusion, depression, and desire to cleanse their body than were participants with higher health literacy. CONCLUSIONS: Interventions are needed to help persons of low literacy adhere to antiretroviral therapies.     

HIV Disclosure Among Women of African Descent: Associations with Coping, Social Support, and Psychological Adaptation

Trained interviewers recruited and interviewed a nonprobability sample of HIV-positive women from outpatient clinics and scatter site housing in New York City. Hispanic Black (n = 37) and non-Hispanic Black (n = 106) women reported high rates of HIV disclosure to family, friends, and lovers; few ethnic differences were noted. Bivariate analyses revealed disclosure was related to greater frequency of HIV-related social support, although not directly to less depressive symptomatology (CES-D) or mood disturbance (POMS-TMD) scores. Additionally, disclosure rates were positively associated with the use of more adaptive coping strategies (i.e., spiritual resilience, constructive cognitions, and community involvement). Multiple regression analyses indicated satisfaction with social support mediated the relationship between adaptive coping and psychological distress. The discussion considers HIV disclosure within the constellation of processes leading to successful adaptation to HIV/AIDS.AIDS Research Program     

Drug Use and Medication Adherence among HIV-1 Infected Individuals

This longitudinal study examined the impact of drug use and abuse on medication adherence among 150 HIV-infected individuals, 102 who tested urinalysis positive for recent illicit drug use. Medication adherence was tracked over a 6-month period using an electronic monitoring device (MEMS caps). Over the 6-month study drug-positive participants demonstrated significantly worse medication adherence than did drug-negative participants (63 vs. 79%, respectively). Logistic regression revealed that drug use was associated with over a fourfold greater risk of adherence failure. Stimulant users were at greatest risk for poor adherence. Based upon within-participants analyses comparing 3-day adherence rates when actively using versus not using drugs, this appears to be more a function of state rather than trait. These data suggest that it is the acute effects of intoxication, rather than stable features that may be characteristic of the drug-using populace, which leads to difficulties with medication adherence.