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

Abstract

The World Health Organisation (WHO) recommends antiretroviral treatment (ART) initiation at human immunodeficiency virus (HIV) diagnosis. As ART programmes expand, addressing barriers to adherence is vital. Past mixed findings on the association between social support, stigma and non-disclosure with ART adherence highlights the need for further research. The primary aim of this study was to examine how these factors are associated with ART non-adherence in the six months after ART initiation. The secondary aim was to explore how other factors are associated with non-adherence. We conducted secondary analysis of prospective data from HIV-positive adults initiating ART. Social support, disclosure patterns, perceived stigma and other demographic factors were collected at ART initiation and six months follow-up. Logistic regression models were used to examine factors associated with self-reported ART non-adherence in the last six months and the last month before the six month follow-up (“recent”). Non-adherence in the last six months was twenty-five percent and recent non-adherence was nine percent. There was no association between non-adherence and social support, stigma or non-disclosure of HIV status. In the final model the odds of non-adherence in the last six months were significantly higher for those: with incomplete ART knowledge (aOR 2.10, 95%CI 1.21–3.66); who visited a healthcare provider for conditions other than HIV (aOR1.98, 95%CI 1.14–3.43); had higher CD4 counts at ART initiation (CD4 100–199:aOR 2.50, 95%CI 1.30–4.81; CD4 ≥ 200:aOR 2.85, 95%CI 1.10–7.40;referent CD4 < 100 cells/mm 3 ); had tested HIV-positive in the last year (aOR 2.00, 95%CI 1.10–3.72; referent testing HIV-positive outside the last year); experienced a rash/itching secondary to ART (aOR 2.48, 95%CI 1.37–4.52); and significantly lower for those ≥48 years (aOR 0.65, 95%CI 0.46–0.90). Early non-adherence remains a concern. Incorporation of adherence monitoring and ART knowledge enhancement into appointments for ART collection may be beneficial.

Do stigma and disclosure of HIV status are associated with adherence to antiretroviral therapy among men who have sex with men?

“…We found no association between perceived stigma or disclosure of HIV status and adherence to ART among MSM in Indonesia. These results are in line with previous studies [2,38].…”

“…Men who have sex with men (MSM) and transgender women are subjected to high levels of human immunodeficiency virus (HIV)-related stigma and often criminalized, affecting access to quality care for sexual health, HIV prevention, and treatment [1,2]. Also, MSM receive stigma, discrimination, judgment, and unfair treatment by health workers in several health services.…”

Prevalence and Determinants of Medication Adherence among Patients with HIV/AIDS in Southern Vietnam

“…Our research also attributed poor adherence to working away from home ( p = 0.011). Various work-related reasons that lead to non-adherence were revealed [ 13 ]. Particularly, the most common causes were due to an intense schedule and fear of stigma at the patients’ workplaces.…”

“…Patients were considered non-adherent when they did not meet at least one of those requirements. In terms of factors associated with patients’ non-adherence, prior studies indicated that the most common causes were alcohol consumption, drug and substance abuse, working away from home and lack of good knowledge about ART adherence and family support [ 11 , 12 , 13 ]. Thus, in addition to patients’ knowledge and adherence, our questionnaire also considered the aforementioned factors.…”

ART initiation and predictive factors among men who have sex with men living with HIV after the implementation of new ART strategy in China: an observational cohort study

“…Social support is protective of mental health problems and utilization of health-related services among MSM [42]. Cohort studies showed that better social support predict better adherence to ART and viral suppression [43,44].…”