OBJECTIVE: Previous research has demonstrated an association between educational attainment (EA) and negative physical and psychological outcomes. This study investigated whether EA is associated with regimen failure during initial therapy with highly active antiretroviral treatment (HAART) and whether adherence self-efficacy (ASE), a coping resource, moderates the relationship between EA and regimen failure. METHODS: A secondary analysis of AIDS Clinical Trial Group Protocol 384, an international, multicenter, randomized, partially double-blinded trial, included 799 male and 181 female antiretroviral-naïve subjects (age, 37.0+/-9.5 years). Participants were recruited from 1998 to 1999 and followed for a median of 2.3 years across 81 centers. The dependent variable was "time to first regimen failure." Covariates include baseline HIV-1 log(10)RNA and CD4(+) counts, self-reported adherence, study site, ASE, age, sex, race, treatment assignment, and baseline use of nonantiretroviral medications. RESULTS: ASE significantly moderated the relationship between EA and regimen failure. Results showed that for every 10-unit increase in ASE, individuals with "less than high school" education had a 17% reduction in regimen failure (hazard ratio=0.83; 95% confidence interval=0.70-0.98) when compared to the reference group "college/graduate," even after adjusting for baseline factors known to contribute to regimen failure. The time to first regimen failure was shorter with decreasing EA, trending toward significance (P=.08). CONCLUSIONS: There is a social gradient in HAART effectiveness, and ASE reduces the deleterious effects of lower EA on regimen failure. We recommend designing controlled interventions to evaluate the effectiveness of programs that increase ASE prior to initiation with HAART, particularly for those with lower EA.
RCT Entities:
OBJECTIVE: Previous research has demonstrated an association between educational attainment (EA) and negative physical and psychological outcomes. This study investigated whether EA is associated with regimen failure during initial therapy with highly active antiretroviral treatment (HAART) and whether adherence self-efficacy (ASE), a coping resource, moderates the relationship between EA and regimen failure. METHODS: A secondary analysis of AIDS Clinical Trial Group Protocol 384, an international, multicenter, randomized, partially double-blinded trial, included 799 male and 181 female antiretroviral-naïve subjects (age, 37.0+/-9.5 years). Participants were recruited from 1998 to 1999 and followed for a median of 2.3 years across 81 centers. The dependent variable was "time to first regimen failure." Covariates include baseline HIV-1 log(10)RNA and CD4(+) counts, self-reported adherence, study site, ASE, age, sex, race, treatment assignment, and baseline use of nonantiretroviral medications. RESULTS: ASE significantly moderated the relationship between EA and regimen failure. Results showed that for every 10-unit increase in ASE, individuals with "less than high school" education had a 17% reduction in regimen failure (hazard ratio=0.83; 95% confidence interval=0.70-0.98) when compared to the reference group "college/graduate," even after adjusting for baseline factors known to contribute to regimen failure. The time to first regimen failure was shorter with decreasing EA, trending toward significance (P=.08). CONCLUSIONS: There is a social gradient in HAART effectiveness, and ASE reduces the deleterious effects of lower EA on regimen failure. We recommend designing controlled interventions to evaluate the effectiveness of programs that increase ASE prior to initiation with HAART, particularly for those with lower EA.
Authors: Andrew J Wawrzyniak; Allan E Rodríguez; Anthony E Falcon; Anindita Chakrabarti; Alexa Parra; Jane Park; Kathleen Mercogliano; Kira Villamizar; Michael A Kolber; Daniel J Feaster; Lisa R Metsch Journal: J Acquir Immune Defic Syndr Date: 2015-05-01 Impact factor: 3.731
Authors: David A Martinez; Kathy Goggin; Delwyn Catley; Mary M Gerkovich; Karen Williams; Julie Wright; Jannette Berkley-Patton Journal: AIDS Behav Date: 2012-11
Authors: Linda G Marc; Whitney R Henderson; Astrid Desrosiers; Marcia A Testa; Samuel E Jean; Eniko Edit Akom Journal: J Gen Intern Med Date: 2014-08-05 Impact factor: 5.128
Authors: Heather J Ribaudo; Kimberly Y Smith; Gregory K Robbins; Charles Flexner; Richard Haubrich; Yun Chen; Margaret A Fischl; Bruce R Schackman; Sharon A Riddler; Roy M Gulick Journal: Clin Infect Dis Date: 2013-09-17 Impact factor: 9.079
Authors: Heather Bailey; Claire L Townsend; Igor Semenenko; Ruslan Malyuta; Mario Cortina-Borja; Claire Thorne Journal: Bull World Health Organ Date: 2013-04-24 Impact factor: 9.408
Authors: Chuka J Anude; Emeka Eze; Henry C Onyegbutulem; Man Charurat; Mary-Ann Etiebet; Samuel Ajayi; Patrick Dakum; Oluyemisi Akinwande; Chris Beyrer; Alash'le Abimiku; William Blattner Journal: BMC Infect Dis Date: 2013-03-01 Impact factor: 3.090