Psychosocial Factors in Adherence to Antiretroviral Therapy among HIV-Positive People Who Use Drugs
OBJECTIVE:
Suboptimal
adherence to antiretroviral therapy (ART) among HIV-infected people who use
illicit drugs (PWUD) remains a significant concern, and there is a lack of
effective adherence interventions for this population. Therefore, we sought to
identify psychosocial determinants of optimal adherence, including adherence
self-efficacy and outcome expectancies, with the aim of informing interventions
designed to improve adherence among PWUD.
METHOD:
From
December 2005 to November 2013, we collected data from the AIDS Care Cohort to
evaluate Exposure to Survival Services (ACCESS), a prospective cohort of PWUD
in Vancouver, Canada. We used multivariable generalized estimating equations
(GEE) analysis to identify longitudinal factors independently associated with
95% or greater adherence to ART.
RESULTS:
Among 667
participants, including 220 (33%) women, 391 (59%) had 95% or greater ART
adherence at baseline. In multivariable GEE analysis, adherence self-efficacy,
adjusted odds ratio (AOR) = 1.16, 95% confidence interval (CI) [1.11, 1.21] per
10-point increase, was independently and positively associated with adherence,
while negative outcome expectancy, AOR = 0.95, 95% CI [0.93, 0.98], was
negatively associated.
CONCLUSION:
In
light of the ongoing challenges associated with ART adherence among
HIV-positive PWUD, and our findings of associations between adherence,
self-efficacy, and outcomes expectancies, tailored intervention strategies
based on constructs of social learning theory should be implemented and
evaluated to improve adherence among HIV-infected PWUD.
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