Brief Report: Linking Depressive Symptoms to Viral Nonsuppression Among Women With HIV Through Adherence Self-Efficacy and ART Adherence
Year: 2020
Type: article
Abstract: BACKGROUND: Depression plays a key role in suboptimal HIV outcomes, possibly mediated by adherence self-efficacy beliefs and antiretroviral treatment (ART) adherence behavior. Applying social-cognitive theory, we examined a longitudinal sequential path model of the association between depressive symptoms and viral nonsuppression in women with HIV (WWH) through these mediating mechanisms. METHODS: This was an observational longitudinal study using data from the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. WWH (N = 375) completed measures of depressive symptoms, adherence self-efficacy, and ART adherence. Viral load was measured through blood draw. We examined a longitudinal sequential path model spanning 3 time points at least 6 months apart between 2015 and 2017. Indirect effects were assessed of depressive symptoms at time 1 (T1) on viral nonsuppression at T3 through adherence self-efficacy at T2 and ART adherence at T3. Covariates included age, income, recreational drug use, race, and months on ART. RESULTS: Depressive symptoms were associated with subsequent viral nonsuppression through its association with adherence self-efficacy and ART adherence [indirect effect: adjusted odds ratio = 1.004, 95% confidence interval: (1.001 to 1.008)]. Months on ART and recreational drug use were also significantly associated with viral nonsuppression at T3. CONCLUSIONS: Our findings support depressive symptoms' association with adherence self-efficacy that in turn lead to suboptimal ART adherence and ultimately to viral nonsuppression for WWH. Tailoring of interventions aimed at addressing depressive symptoms, substance use, and adherence self-efficacy among WWH is needed to help close the gap between ART prescription and viral suppression on the HIV care continuum.
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, Agency for Healthcare Research and Quality, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Acute Effects of Cannabis on Cognition and Mobility in Older HIV-Infected and Uninfected Women", Emory R38 Research Training Program, Emory WIHS CRS - Longitudinal Cohort, UAB Institutional Career Development Program in HIV-Related Heart, Lung, Blood and Research, The Connie Wofsy Women's HIV Study, Brooklyn Women's Interagency HIV Study (WIHS) V, Miami Womens Interagency HIV Study WIHS, WIHS Data Management and Analysis Center (WDMAC), Southern California Women's Interagency HIV Study Consortium, Chicago WIHS Consortium V (CWC), Washington Women's Interagency HIV/AIDS Study, UAB HEALTH SERVICES & OUTCOMES RESEARCH TRAINING PROGRAM, Clinical and Translational Science Institute, Atlanta Clinical and Translational Science Institute (ACTSI) Renewal, Mechanisms and longitudinal effects of stigma on women's adherence and outcomes, University of North Carolina Womens Interagency HIV Study UNC WIHS, Women's Interagency HIV Study (WIHS-V), UAB-MISS WIHS Cohort, MACS/WIHS -CCS, Emory Specialized Center of Research Excellence (SCORE) on Sex Differences, SF Bay Area MACS/WIHS Combined Cohort Study, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, MACS/WIHS Combined Cohort Study: Cook County Clinical Research Site (CC_CRS), The University of North Carolina Center for AIDS Research, Center for AIDS Prevention Studies (CAPS), MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), UCSF-Bay Area Center for AIDS Research, UAB-MISS MACS/WIHS Combined Cohort Study, Extreme heat, pollution, wildfire smoke, and aging among people living with or at risk for HIV, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W2997734855