Kaylee B Crockett1, Kristin J Entler2, Emilee Brodie2, Mirjam-Colette Kempf3, Deborah Konkle-Parker4, Tracey E Wilson5, Phyllis C Tien6,7, Gina Wingood8, Torsten B Neilands9, Mallory O Johnson9, Sheri D Weiser10, Janet M Turan1, Bulent Turan2. 1. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL. 2. Department of Psychology, University of Alabama at Birmingham, Birmingham, AL. 3. Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, AL. 4. Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS. 5. Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY. 6. Department of Medicine, University of California, San Francisco and Medical Service, San Francisco, CA. 7. Department of Veteran Affairs Medical Center, San Francisco, CA. 8. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. 9. Department of Medicine, University of California, San Francisco, San Francisco, CA; and. 10. Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
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.
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.
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