Depression, Substance Abuse and Other Contextual Predictors of Adherence to Antiretroviral Therapy (ART) Among Haitians

Abstract

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti's resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

“…Such poor support has been shown to have a negative impact on adherence to ART [11]. In addition, HIV-positive people who use alcohol frequently can experience more conflict with their partners, which can impact negatively on spousal support and lead to poor compliance with ART [12]. Harmful alcohol drinking can also reduce coping skills and increase the likelihood of opportunistic infections [13].…”

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

“…Asimismo, encontramos asociación de la presencia de comorbilidades a la adherencia al TAR-GA, situación que ha sido descrita en otras series 25,36,61,62 . En nuestro estudio no se contó con el número suficiente de casos para tener una frecuencia específica por cada enfermedad que permita incluir en el análisis de asociación.…”

“…Puesto que existe una alta asociación entre la adherencia y la depresión en general y en pacientes con VIH 25,26,40,41,61 . Asimismo, la alta correlación descrita entre depresión y calidad de sueño, y sobre todo por el hecho que dentro del constructo de depresión incluye una dimensión relacionada a trastornos del sueño, lo que se ve reflejado en la inclusión de ítems dentro de varios de los cuestionarios utilizados para medir depresión 63 , ha generado un debate en la academia sobre todo acerca de la direccionalidad de la asociación.…”

“…Sin embargo, la adherencia se ve afectada por múltiples factores, en particular por los efectos secundarios del tratamiento 17,18,19,20 . Problemas de salud mental como la depresión 21 , así como el consumo de alcohol 22,23 y el abuso de sustancias, se asocian también a una baja adherencia al tratamiento 20,24,25,26,27,28,29 . Además, se ha encontrado asociación con efectos adversos específicos de los antirretrovirales 30,31 , entre otras causas 32,33 .…”

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…ART has played a significant role not only in reducing mortality and improving the quality of life of persons living with HIV, but also in helping them achieve long-term optimal health and almost certainly in reducing HIV incidence (UN Development Programme, 2013;Donnell et al, 2010;Palombi et al, 2012;Bangsberg, Moss, & Deeks, 2004;Carpenter since the 2010 earthquake (Wood et al, 2009;Malow et al, 2010;Moatti, 2002;Safren et al, 2001;Koenig et al, 2010). Research has identified multiple barriers to ART adherence and response, including poor social support Bryant, 2006), alcohol abuse Baum et al, 2010;Malow et al, 2013;Nachega et al, 2005), negative beliefs about medicine (DiMatteo, Lepper, & Croghan, 2000;Starace et al, 2002), depression and anxiety Starace et al, 2002;Weaver et al, 2005;Krain & Fitzgerald, 2005;Ghose et al, 2013), and stigma (Castro & Farmer, 2005;Dévieux et al, 2004;Vyavaharkar et al, 2007).…”