Differential Predictors of Medication Adherence in HIV: Findings from a Sample of African American and Caucasian HIV-Positive Drug-Using Adults

Thames, April D.; Moizel, Jennifer; Panos, Stella E.; Patel, Shreya; Byrd, Desiree; Myers, Héctor F.; Wyatt, Gail E.; Hinkin, Charles H.

doi:10.1089/apc.2012.0157

Cited by 44 publications

(39 citation statements)

References 57 publications

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“…These findings seem to resonate with other recent studies of substance abusing PLWHA, which have documented that differences in stress tolerance (one's ability or perceived capacity to tolerate distress) and health care provider interest and satisfaction also play an important role in ARV medication adherence. 39,40 In contrast, diverters had higher stigma related to disclosure, indicating that perhaps the need or desire to conceal HIV status could potentially play a role in the decision to divert medications. Although these associations did not remain significant in the multivariate analyses, these results may indicate that decreases in stigma related to disclosure would be useful in promoting adherence and reducing diversion among this highly marginalized population of PLWHA, making this a potential target for intervention.…”

Section: Discussionmentioning

confidence: 99%

HIV Stigma Among Substance Abusing People Living with HIV/AIDS: Implications for HIV Treatment

Levi-Minzi

Surratt

2014

AIDS Patient Care and STDs

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HIV-related stigma has a major impact on quality of life and health among people living with HIV and AIDS (PLWHA). This study examines demographic, mental health, behavioral, contextual, and HIV care-related correlates of HIV stigma among 503 substance abusing PLWHA. Stigma was measured with the HIV Internalized Stigma Measure which has four subscales: stereotypes about HIV, self-acceptance, disclosure concerns, and social relationships. Severe substance dependence (55.3%) and depression (54.7%) were associated with higher HIV stigma across all domains. 49.9% of the sample reported antiretroviral (ARV) medication diversion (the unlawful sale and trading of ARV medications); diverters endorsed significantly higher stigma related to disclosure. 54.1% of the sample reported ≥95% ARV adherence; these individuals reported significantly lower stigma for self-acceptance, disclosure, and social relationships. Multivariate linear regression showed that depression and social support demonstrated significant main effects across stigma domains. Findings suggest that interventions to decrease HIV related stigma may be an important component of initiatives to increase engagement in HIV care.

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Section: Discussionmentioning

confidence: 99%

HIV Stigma Among Substance Abusing People Living with HIV/AIDS: Implications for HIV Treatment

Levi-Minzi

Surratt

2014

AIDS Patient Care and STDs

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“…Patient satisfaction with care is a factor associated with improved medication adherence [51][52][53][54] and healthrelated quality of life [52], and consequently it was a predictor of CD4 cell recovery in our patients. Clinic travel costs, which were found to have a borderline significant effect on virological suppression, represent a barrier to accessing care and medication refills.…”

Section: Discussionmentioning

confidence: 99%

“…The association between increases in total lymphocyte count from baseline and CD4+ cell recovery is not surprising, as CD4 cells are included in the total lymphocyte count, but increased total lymphocyte count after ART is associated with increased lymphocyte proliferation in response to an antigen [48]. Some have advocated the use of the total lymphocyte count as an inexpensive indicator for tracking HIV disease progression in resource-poor settings [49]; however, more recent studies demonstrate low sensitivity and specificity of total lymphocyte count as a surrogate measure of CD4 cell count [50].Patient satisfaction with care is a factor associated with improved medication adherence [51][52][53][54] and healthrelated quality of life [52], and consequently it was a predictor of CD4 cell recovery in our patients. Clinic travel costs, which were found to have a borderline significant effect on virological suppression, represent a barrier to accessing care and medication refills.…”

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confidence: 99%

Evaluation of treatment outcomes for patients on first‐line regimens in US President's Emergency Plan for AIDS Relief (PEPFAR) clinics in Uganda: predictors of virological and immunological response from RV288 analyses

et al. 2014

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ObjectivesViral load (VL) monitoring is recommended, but seldom performed, in resource-constrained countries. RV288 is a US President's Emergency Plan for AIDS Relief (PEPFAR) basic programme evaluation to determine the proportion of patients on treatment who are virologically suppressed and to identify predictors of virological suppression and recovery of CD4 cell count. Analyses from Uganda are presented here. MethodsIn this cross-sectional, observational study, patients on first-line antiretroviral therapy (ART) (efavirenz or nevirapine + zidovudine/lamivudine) from Kayunga District Hospital and Kagulamira Health Center were randomly selected for a study visit that included determination of viral load (HIV-1 RNA), CD4 cell count and clinical chemistry tests. Subjects were recruited by time on treatment: 6-12, 13-24 or > 24 months. Logistic regression modelling identified predictors of virological suppression. Linear regression modelling identified predictors of CD4 cell count recovery on ART. ResultsWe found that 85.2% of 325 subjects were virologically suppressed (viral load < 47 HIV-1 RNA copies/ml). There was no difference in the proportion of virologically suppressed subjects by time on treatment, yet CD4 counts were higher in each successive stratum. Women had higher median CD4 counts than men overall (406 vs. 294 cells/μL, respectively; P < 0.0001) and in each time-on-treatment stratum. In a multivariate logistic regression model, predictors of virological suppression included efavirenz use [odds ratio (OR) 0.47; 95% confidence interval (CI) 0.22-1.02; P = 0.057], lower cost of clinic visits (OR 0.815; 95% CI 0.66-1.00; P = 0.05), improvement in CD4 percentage (OR 1.06; 95% CI 1.014-1.107; P = 0.009), and care at Kayunga vs. Kangulamira (OR 0.47; 95% CI 0.23-0.92; P = 0.035). In a multivariate linear regression model of covariates associated with CD4 count recovery, time on highly active antiretroviral therapy (ART) (P < 0.0001), patient satisfaction with care (P = 0.038), improvements in total lymphocyte count (P < 0.0001) and haemoglobin concentration (P = 0.05) were positively associated, whereas age at start of ART (P = 0.0045) was negatively associated with this outcome. ConclusionsHigh virological suppression rates are achievable on first-line ART in Uganda. The odds of virological suppression were positively associated with efavirenz use and improvements in CD4 cell percentage and total lymphocyte count and negatively associated with the cost of travel to The US President's Emergency Plan for AIDS Relief (PEPFAR), launched in 2002, has played a major role in the rapid scale-up of and expanded access to ART in resourcelimited countries, particularly in sub-Saharan Africa. In the opening session of the 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013), Dr Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC), articulated the goals of interventions in the global HIV epidemic, stating, 'the proportion of patients with viral suppression should be the p...

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“…[9][10][11] Additionally, African Americans have an increased rate of HIV infection, enter care later in the course of the disease, are less likely to initiate antiretroviral (ARV) therapy, and have lower levels of ARV adherence in comparison to White individuals. [12][13][14] From 2006 to 2009, a major driver of the increased incidence of HIV was a 48% increase in the rate of infection among young African American men who have sex with men. 8 Taken together, African American youth have a higher rate of HIV infection, have an elevated likelihood of worse outcomes, and have been the target population for much research and interventions to improve engagement in care and enhance adherence to ARV therapy.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study to Engage and Counsel HIV-Positive African American Youth Via Telehealth Technology

Saberi

Yuan

John

et al. 2013

AIDS Patient Care and STDs

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Antiretroviral nonadherence is a strong determinant of virologic failure and is negatively correlated with survival. HIV-positive African American youth have lower antiretroviral adherence and treatment engagement than other populations. We assessed the feasibility and acceptability of a telehealth (remote videoconferencing) medication counseling intervention as an innovative approach to address these disparities. HIV-positive African American youth (18-29 years old) on antiretrovirals were enrolled in a telehealth medication counseling session, followed by a semi-structured qualitative interview to explore likes/dislikes of the format, modality, and content; potential impact on adherence; privacy issues; and interaction quality. Fourteen participants with a mean age of 24 years, who were 86% male, and had a mean self-reported adherence in the past month of 89%, were interviewed. Participants stated that they liked telehealth, would use it if offered in clinic/research settings, and indicated that their privacy was maintained. Participants described telehealth as convenient and efficient, with positive impact on their knowledge. Telehealth provided a modality to interact with providers that participants described as less intimidating than in-person visits. Telehealth is feasible and acceptable for delivering medication counseling to HIV-positive African American youth when conducted in a controlled clinical setting and may improve quality of patient-provider dialogue. Use of telehealth may lead to more disclosure of treatment difficulties, increased patient comfort, and improved health education.

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Differential Predictors of Medication Adherence in HIV: Findings from a Sample of African American and Caucasian HIV-Positive Drug-Using Adults

Cited by 44 publications

References 57 publications

HIV Stigma Among Substance Abusing People Living with HIV/AIDS: Implications for HIV Treatment

HIV Stigma Among Substance Abusing People Living with HIV/AIDS: Implications for HIV Treatment

Evaluation of treatment outcomes for patients on first‐line regimens in US President's Emergency Plan for AIDS Relief (PEPFAR) clinics in Uganda: predictors of virological and immunological response from RV288 analyses

A Pilot Study to Engage and Counsel HIV-Positive African American Youth Via Telehealth Technology

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