Associations Between Alcohol Use, Other Psychosocial Factors, Structural Factors and Antiretroviral Therapy (ART) Adherence Among South African ART Recipients

Morojele, Neo K.; Kekwaletswe, Connie T.; Nkosi, Sebenzile

doi:10.1007/s10461-013-0583-0

Cited by 52 publications

(67 citation statements)

References 11 publications

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“…Six investigations found that stigma was significantly associated with poor self-reported adherence at the multivariate level, after adjusting for factors such as demographics, perceived health, structural barriers, and alcohol and drug use [42,44,45,47,49,56]. Two prospective investigations lent support to this association as well.…”

Section: Studies That Combined Multiple Dimensions Of Stigmamentioning

confidence: 93%

“…However, multivariate and mediational analyses differed, so both were retained for the review. An additional two studies [44,45] reported on the same dataset, but different adherence outcomes were used in analyses, so both were retained.…”

Section: Search Strategy and Study Selectionmentioning

confidence: 99%

“…These instruments are characterized by a range of subconstructs, including internalized (e.g., negative self-perception), anticipated (e.g., renegotiating social relationships), and enacted (e.g., healthcare discrimination) stigmas. A combination of enacted and anticipated stigma items was used for two studies [44,45], but the exact stigma measure used was not mentioned.…”

Section: Studies That Combined Multiple Dimensions Of Stigmamentioning

confidence: 99%

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The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

2015

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This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.

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Section: Studies That Combined Multiple Dimensions Of Stigmamentioning

confidence: 93%

Section: Search Strategy and Study Selectionmentioning

confidence: 99%

Section: Studies That Combined Multiple Dimensions Of Stigmamentioning

confidence: 99%

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The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

2015

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“…Alcohol use was associated with non-adherence to antiretroviral therapy among HIV infected people in Pwani Region, eastern Tanzania [45]. Likewise, study done in South Africa showed that alcohol use is independently associated with antiretroviral adherence [46]. Study done in South India also indicated the association of alcohol use with non-adherence [47].…”

Section: Alcohol Drinkers and Non-adherence To Antiretroviral Therapymentioning

confidence: 94%

Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia

Dibaba¹,

Hussein²

2017

J AIDS Clin Res

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“…We will recruit participants from each site without an attempt to have equal numbers of men and women; we anticipate a ratio of about 2:1 females to males. Based on our prior data [44], we would estimate that about 40% of ART recipients will be alcohol drinkers. Of the alcohol drinkers, we estimate that about 15% would meet the criterion related to alcohol (have six (or four, if female) or more drinks on one occasion at least weekly, and score no more than 22 on the AUDIT).…”

Section: Methodsmentioning

confidence: 99%

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

et al. 2014

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BackgroundLittle research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention.Methods/DesignA randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions.DiscussionWe have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes.Trial registrationPan African Clinical Trials Register Number: PACTR201405000815100.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-500) contains supplementary material, which is available to authorized users.

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Associations Between Alcohol Use, Other Psychosocial Factors, Structural Factors and Antiretroviral Therapy (ART) Adherence Among South African ART Recipients

Cited by 52 publications

References 11 publications

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia

Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol

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