Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa

Abstract

We sought to (a) replicate and (b) extend (via the addition of alcohol use) Cha et al.'s cross-sectional multi-component model of ART adherence on the relationship between social support, depression, self-efficacy beliefs, and antiretroviral therapy (ART) adherence, among HIV patients in Tshwane, South Africa. Using purposive sampling, 304 male and female ART recipients were recruited. ART adherence was assessed using three manifest indicators: total adherence ratio, the CASE adherence index and 1-month adherence measure. Data were analysed using structural equation modeling. In our replicated model, social support had both direct and indirect relationships with ART adherence, and inclusion of alcohol use improved prediction of ART adherence. Direct and indirect effects of alcohol use on ART adherence emerged: adherence self-efficacy beliefs partially mediated the latter path. Findings highlight the importance of integrating into ART promotion interventions, the reduction of alcohol use, provision of social support, and enhancement of adherence self-efficacy beliefs.

Antiretroviral therapy adherence and its determinant factors among people living with HIV/AIDS: a case study in Iran

“…Part six was about alcohol consumption (in the last 30 days) and drug abuse (in the last 6 months), which should be answered on a seven-point Lickert scale (never = zero, once a month = 1, two or three times a month = 2, once or twice a week = 3, three or four times a week = 4, almost every day = 5, and daily = 6). Kekwaletswe et al confirmed the validity and reliability of this questionnaire by Cronbach’s alpha (0.71) [11, 12]. To conduct this study in the Iranian culture and among the people of Kerman, the necessary adjustments were made in the ACTG questionnaire.…”

Resilience and HIV: a review of the definition and study of resilience

“…These studies focused mostly on associations of resilience resources such as coping, self-efficacy, control beliefs, and social support with ART adherence. Although the findings regarding the aforementioned relationships were mixed [(e.g., (Harzke et al, 2004;Simoni et al, 2002)], the majority of the findings supported associations between social support and ART adherence [e.g., (Kekwaletswe et al, 2017;Peltzer et al, 2010)]. Some of the longitudinal findings indicated that control beliefs , social support and self-efficacy for medication taking (Cha et al, 2008) predicted ART adherence.…”

“…However, Peltzer et al (2010) found that spirituality exhibited an inverse relationship with ART. The Cha, Erlen, Kim, Sereika, and Caruthers (2008) article tested a model of ART adherence that was also used by Kekwaletswe, Jordaan, Nkosi, and Morojele (2017). Both of the aforementioned studies found indirect associations of social support with ART adherence via medication taking self-efficacy and that self-efficacy mediated the relationship of depression on ART adherence.…”

Social support, disclosure and stigma and the association with non-adherence in the six months after antiretroviral therapy initiation among a cohort of HIV-positive adults in rural KwaZulu-Natal, South Africa

“…However, we found no association between disclosure to a partner and non-adherence. Secondly, past studies indicate that depression and lack of belief in own self-efficacy are associated with both low social support and increased non-adherence in HIV-positive adults in SSA (Conroy et al., 2017; Hunter-Adams et al., 2017; Kekwaletswe, Jordaan, Nkosi, & Morojele, 2016; Ncama et al., 2008). Our study did not measure these factors, so it is possible that residual confounding by these factors contributed to the difference between our results and previous research Finally, the majority of research in this area has collected qualitative data, which may better reflect relationship dynamics and individualised support networks provided by friends and family than the quantitative measures used in our analyses (Conroy et al., 2017; Hunter-Adams et al., 2017).…”