Changes in Stress, Substance Use and Medication Beliefs are Associated with Changes in Adherence to HIV Antiretroviral Therapy

Abstract

Stress, substance use and medication beliefs are among the most frequently cited barriers to HIV treatment adherence. This study used longitudinal techniques to examine the temporal relationship between these barriers and adherence among clients attending treatment adherence support programs in New York State. A total of 4,155 interview pairs were analyzed across three interview transitions. Multinomial models were constructed with four-category change-based independent variables (e.g., low stress at both interviews, low stress at interview 1 and high stress at interview 2, high stress at interview 1 and low stress at interview 2, high stress at both interviews) that predicted a similarly constructed four-category adherence change variable. Clients who reported positive changes in stress, substance use, or medication beliefs were more likely to change from being nonadherent to being adherent, while clients who reported negative changes were more likely to change from being adherent to being nonadherent. To improve or maintain adherence over time, strategies should be used that facilitate positive changes-and prevent negative changes-in stress, substance use, and medication beliefs.

Factors Associated With Returning to HIV Care After a Gap in Care in New York State

“…It is no surprise that life stressors may be barriers to achieving optimal HIV care utilization, as HIV-positive individuals tend to be marginalized in many ways, which can lead to an additional level of burden that may take priority over seeking medical care. This theme is consistent with other studies 2141, 42 . Taken together, the lack of consistent emerging themes in our and others’ studies to explain patients’ gaps in care leaves medical providers and policy makers uncertain on how to mitigate or prevent gaps in care.…”

Correlates of antiretroviral adherence and viral load among transgender women living with HIV

“…This corroborates findings that stress is associated with nonadherence (French, Tesoriero, & Agins, 2011), and trauma is associated with treatment failure among women, including transgender women (Machtinger, Haberer, Wilson, & Weiss, 2012). Future research should examine the role of coping in the improvement of health outcomes for transgender women living with HIV.…”

Psychosocial correlates of medication adherence among HIV-positive, cognitively impaired individuals

“…Perceived stress level stability served as a protective factor, supporting previous research on the detrimental impact of increased stress on treatment adherence (e.g., French, Tesoriero, & Agins, 2011; Gebo, Keruly, & Moore, 2003; Leserman, Ironson, O’Cleirigh, Fordiani, & Balbin, 2008; Mugavero et al, 2009) by highlighting its specific importance within a cognitively impaired sample. As increased stress has related to cognitive dysfunction among HIV patients (Pukay-Martin, Cristiani, Saveanu, & Bornstein, 2003), this population may be particularly susceptible to the adverse consequences of increased life stressors on treatment adherence.…”