Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: −64.3%, −15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.
BACKGROUND: Centers for Independent Living (CILs) can help out of school youth with disabilities. CIL services may be particularly important for minority youth with disabilities that face additional transition barriers. OBJECTIVE: This literature review documents existing practices that might aid CILs as they seek to help youth, including minority youth, with disabilities transition to adult life. METHODS: First, we conducted a literature search to identify practices that might help CILs assist youth with disabilities transition to independent living (IL) in early adult life. Then we examined various literature syntheses of postsecondary transition interventions with evidence of promise or efficacy for any IL-related outcome—regardless of whether the intervention targeted youth with disabilities. RESULTS: We discovered a variety of practices CILs might learn from or consider adopting to help youth with disabilities transition to adult life. However, the practices rarely focused on minority youth and usually had limited or no evidence about whether they improved IL outcomes. CONCLUSIONS: The limitations of the evidence we found suggest the need to develop and test interventions that help transition age youth with disabilities—especially minority youth with disabilities—achieve their IL goals.
Objectives Antiretroviral (ARV) adherence is a strong predictor of improved health outcomes and treatment effectiveness among persons living with HIV. Food insecurity and low social support are have been demonstrated to predict reported nonadherence among pregnant women, but the relationship has not been evaluated using an objective indicator of adherence. Therefore, we explored the impacts of social support and food insecurity on ARV adherence using ARV drug concentrations in hair among postpartum Kenyan women living with HIV. Methods Hair samples were collected from 83 HIV + women, a subset from an observational pregnancy cohort study (NCT02974972), on Efavirenz (n = 58) and Nevirapine (n = 25)-based ARVs at nine months postpartum. Hair ARV concentrations were log transformed to approximate a normal distribution. Food insecurity [Individual Food Insecurity Access Scale (IFIAS, 0–27)], social support (Perceived Social Support Scale, 0–40), and quality of life (Short Form 8 Health Survey, 0–40] were recalled for the prior month. These covariables, along with sociodemographic characteristics, were included in a multivariable linear regression model (P < 0.2) and eliminated using a backward stepwise approach (P < 0.1). Results Mean IFIAS score was 10.0 (± 5.2). Lower food insecurity and greater quality of life were significantly associated with higher hair ARV concentrations. Each point increase in IFIAS and decrease in quality of life was associated with a 13.4% decrease (95%CI: −0.23, −0.05) and 15.7% decrease (95%CI: 0.06, 0.23) in hair levels, respectively. Social support was not significantly associated with ARV adherence in bivariate analysis, but did buffer against the negative impacts of food insecurity on ARV adherence in the final multivariable model (Figure 1). Conclusions This study demonstrates that low food insecurity is significantly associated with higher ARV adherence among postpartum women using an objective biomarker, and that social support can buffer the negative effect of food insecurity on adherence. Interventions addressing these modifiable barriers to ARV adherence should be explored to improve adherence among HIV + postpartum women. Funding Sources The study was supported by the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases. Supporting Tables, Images and/or Graphs
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