Mental Health and ART Adherence in a Multisite International Study: The Mediating Roles of Social Support and Substance Use in People with HIV
Year: 2026
Type: article
Study design: Observational Study
Abstract: ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental health-adherence link. Cocaine, Amphetamine-type stimulants, inhalants, and opioids directly influenced adherence but did not mediate this relationship. In contrast, no significant effects were observed for tobacco, alcohol, cannabis or sedatives. This large-scale, nurse-led, international study offers critical insights into the roles of social support and substance use as psychosocial influencers in the cascade of care for PLHIV. Clinical implications include prioritizing educative, preventative, and harm-reductive approaches to specific substances that impact ART adherence. Findings may also inform interventions that emphasize strengthening social support to improve adherence in ART and care while addressing substance use as a barrier to care and well-being.
Source: AIDS and Behavior
Authors: Joseph Awad, Wenxiu Sun, Diane Santa Maria, Rebecca Schnall, Panta Apiruknapanond, Tongyao Wang, Claudia Patricia Valencia, Christine Horvat Davey, Solymar Solis Baez, Emilia Iwu, Motshedisi Sabone, Lufuno Makhado, Yvette P. Cuca, J. Craig Phillips, Inge B. Corless, Sheila Shaibu, Carol Dawson-Rose, Wei-Ti Chen
Institutions: University of California, Los Angeles, Fudan University, Shanghai Public Health Clinical Center, The University of Texas Health Science Center at Houston, Columbia University, Saint Louis College, University of Hong Kong, Universidad del Valle, Case Western Reserve University, Auxilio Mutuo Hospital, Rutgers, The State University of New Jersey, University of Venda, University of California, San Francisco, University of Ottawa, MGH Institute of Health Professions, Aga Khan University, Aga Khan University Nairobi
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
Funders: Shanghai Municipal Health Commission, National Institutes of Health, Agency for Healthcare Research and Quality, University of California, Los Angeles, University of California, San Francisco, National Institute of Mental Health, National Cancer Institute, National Institute of Nursing Research
OpenAlex ID: W7125518904