Adherence to Antiretroviral Medication Regimens: A Test of a Psychosocial Model

Abstract

Objective-The primary aim of this study was to test a psychosocial model of medication adherence among people taking antiretroviral medications. This model was based primarily on social cognitive theory and included personal (self-efficacy, outcome expectancy, stigma, depression, and spirituality), social (social support, difficult life circumstances), and provider (patient satisfaction and decision-making) variables. © Springer Science+Business Media, LLC 2007Correspondence to: Colleen DiIorio, cdiiori@sph.emory.edu. Design-The data for this analysis were obtained from the parent study, which was a randomized controlled trial (Get Busy Living) designed to evaluate an intervention to foster medication adherence. Factor analysis was used to develop the constructs for the model, and structural equation modeling was used to test the model. Only baseline data were used in this cross sectional analysis. NIH Public AccessMethods-Participants were recruited from a HIV/AIDS clinic in Atlanta, GA. Prior to group assignment, participants were asked to complete a questionnaire that included assessment of the study variables.Results-A total of 236 participants were included in the analysis. The mean age of the participants was 41 years; the majority were male, and most were African-American. In the final model, self-efficacy and depression demonstrated direct associations with adherence; whereas stigma, patient satisfaction, and social support were indirectly related to adherence through their association with either self-efficacy or depression.Conclusion-These findings provide evidence to reinforce the belief that medication-taking behaviors are affected by a complex set of interactions among psychosocial variables and provide direction for adherence interventions.

Prevalencia, factores de riesgo y manejo de la depresión en pacientes con infección por VIH: Revisión de la literatura

“…Al respecto, una condición básica para este éxito terapéutico, compartida por muy pocas otras enfermedades, es un cumplimiento extremo de la indicación medicamentosa (adherencia). Pequeños incumplimientos de esta adherencia, se asocian a fracaso terapéutico (pérdida de la capacidad de suprimir la replicación viral con la consiguiente progresión de la enfermedad), agravado por la pérdida de efectividad de los anti-retrovirales previamente usados (desarrollo de resistencia) 29,[34][35][36] . Entre los factores psico-sociales más importantes para la pérdida de adherencia están: la falta de una red de apoyo social, el abuso de sustancias y la depresión 23,28,29,[34][35][36][37][38][39] .…”

“…Pequeños incumplimientos de esta adherencia, se asocian a fracaso terapéutico (pérdida de la capacidad de suprimir la replicación viral con la consiguiente progresión de la enfermedad), agravado por la pérdida de efectividad de los anti-retrovirales previamente usados (desarrollo de resistencia) 29,[34][35][36] . Entre los factores psico-sociales más importantes para la pérdida de adherencia están: la falta de una red de apoyo social, el abuso de sustancias y la depresión 23,28,29,[34][35][36][37][38][39] . Se considera que la depresión no tratada es, a su vez, un factor de riesgo para el abuso de sustancias y el uso de terapias alternativas o la automedicación, con el subsecuente perjuicio en la adherencia y efectividad de la TAR 4,11,18,28,31,32 .…”

Influence of Spirituality and Religion on Adherence to Highly Active Antiretroviral Therapy in Adult HIV/AIDS Patients in Calabar, Nigeria

“…Similarly, Trevino et al in a cross-sectional longitudinal study in Cincinnati, USA, reported that positive religious coping was associated with positive outcomes such as better QoL, improved clinical outcome, and adherence [47]. This findings in this study may have been due to the possible role of positive religious coping in helping patients maintain a positive attitude to life, promote active coping with health problems, fostering emotional wellbeing, establishing and maintaining social support, facilitating meaning making, and improved self-efficacy [48]. This is in tune with other studies in diverse settings, which reported positive association between the level of positive spiritual coping and the physical as well as mental health [4,49,50].…”

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

“…The positive association between social support and adherence to ART regimens among PLWH is well documented Diiorio et al, 2009;Gordillo, del Amo, Soriano, & González-Lahoz, 1999;Holzemer, 1999;, although few studies have focused on specific roles and mechanisms of social support. A meta-analysis found that, among people with different diseases, practical support was a much stronger predictor of treatment adherence than emotional support , but this analysis excluded studies that involved substance abusing populations.…”

“…financial) support was more closely associated with treatment access (Knowlton et al, 2001). One study found that social support did not directly influence ART adherence among PLWH, but instead acted through the mediators, depression and self-efficacy (Diiorio et al, 2009). Similarly found that social support operated through affect and spirituality in its relationship with efficacy to adhere to ART.…”