Hilary L Surratt1, Steven P Kurtz1, Maria A Levi-Minzi1, Minxing Chen1. 1. Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston.
Abstract
OBJECTIVES: We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. METHODS: Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. RESULTS: The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. CONCLUSIONS: Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.
OBJECTIVES: We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. METHODS: Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. RESULTS: The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. CONCLUSIONS: Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.
Authors: Michael-John S Milloy; Brandon D L Marshall; Thomas Kerr; Jane Buxton; Tim Rhodes; Julio Montaner; Evan Wood Journal: AIDS Date: 2012-06-01 Impact factor: 4.177
Authors: Adam S Vaughan; Michael R Kramer; Hannah L F Cooper; Eli S Rosenberg; Patrick S Sullivan Journal: Soc Sci Med Date: 2016-12-24 Impact factor: 4.634
Authors: Richard V Remigio; Garazi Zulaika; Renata S Rabello; John Bryan; Daniel M Sheehan; Sandro Galea; Marilia S Carvalho; Andrew Rundle; Gina S Lovasi Journal: J Urban Health Date: 2019-08 Impact factor: 3.671
Authors: Hong-Van Tieu; Beryl A Koblin; Carl Latkin; Frank C Curriero; Emily R Greene; Andrew Rundle; Victoria Frye Journal: J Urban Health Date: 2020-10 Impact factor: 3.671
Authors: Kaylee B Crockett; Andrew Edmonds; Mallory O Johnson; Torsten B Neilands; Mirjam-Colette Kempf; Deborah Konkle-Parker; Gina Wingood; Phyllis C Tien; Mardge Cohen; Tracey E Wilson; Carmen H Logie; Oluwakemi Sosanya; Michael Plankey; Elizabeth Golub; Adaora A Adimora; Carrigan Parish; Sheri D Weiser; Janet M Turan; Bulent Turan Journal: AIDS Patient Care STDS Date: 2019-06 Impact factor: 5.078
Authors: Gregory Phillips Ii; David J McCuskey; Dylan Felt; Anand B Raman; Christina S Hayford; Jim Pickett; Julia Shenkman; Peter T Lindeman; Brian Mustanski Journal: Soc Sci Med Date: 2020-11-04 Impact factor: 4.634
Authors: Peter F Rebeiro; Chanelle J Howe; William B Rogers; Sally S Bebawy; Megan Turner; Asghar Kheshti; Catherine C McGowan; Stephen P Raffanti; Timothy R Sterling Journal: AIDS Care Date: 2018-04-20
Authors: Ian A Wright; Rachelle Reid; Naysha Shahid; Amanda Ponce; C Mindy Nelson; Jasmyn Sanders; Nadine Gardner; Jingxin Liu; Ervin Simmons; Arnetta Phillips; Yue Pan; Maria L Alcaide; Allan Rodriguez; Gail Ironson; Daniel J Feaster; Steven A Safren; Sannisha K Dale Journal: Am J Public Health Date: 2022-06 Impact factor: 11.561
Authors: Jennifer L Glick; Aimee Huang; Rienna Russo; Belinda Jivapong; Vijayasundaram Ramasamy; Lori Rosman; Danielle Pelaez; Katherine H A Footer; Susan G Sherman Journal: Drug Alcohol Depend Date: 2020-08-02 Impact factor: 4.492