Exploring the dynamics of ART adherence in the context of a mindfulness instruction intervention among youth living with HIV in Baltimore, Maryland

Abstract

Youth living with HIV have sub-optimal rates of adherence to antiretroviral therapy (ART). Mindfulness instruction interventions have shown promise for improving medication adherence, but the effects and mechanisms of these interventions are still being explored among people living with HIV, including youth. In the context of a randomized controlled trial of the efficacy of a Mindfulness-Based Stress Reduction (MBSR) program on ART adherence and viral suppression among youth living with HIV, we conducted 44 iterative, semi-structured, in-depth interviews with 20 study participants (13-24 years) recruited from clinics at two academic centers in Baltimore, Maryland. Interviews explored the social context and psychosocial dynamics of ART adherence in the context of the MBSR intervention, compared with those in a control arm. We employed thematic content analysis to systematically code and synthesize textual interview data. Participants' challenges with ART adherence were often situated within an ongoing process of working to manage HIV as a stigmatized, chronic condition in addition to other intersecting social stigmas, inequalities, and stressors. Participation in the MBSR program and related group support allowed participants to non-judgmentally observe and accept difficult thoughts, feelings, and experiences associated with living with HIV and taking ART, which facilitated greater reported adherence. Mindfulness training may stimulate new perspectives and understanding, including greater self- and illness-acceptance among youth living with HIV, leading to improved HIV outcomes.

Pregnancy in an Urban Cohort of Adolescents Living with Human Immunodeficiency Virus: Characteristics and Outcomes in Comparison to Adults

“…16 Studies have demonstrated improved adherence with mobile games, web-based interventions, interactive text message reminders, and mindfulness interventions in the US ALWHIV. [17][18][19][20] Several additional studies investigating novel approaches for ALHIV engagement in care are ongoing. [21][22][23][24] These interventions should be studied in pregnancy as well.…”

Preventing mental health conditions in adolescents living with HIV: an urgent need for evidence

“…Research using process data holds important lessons for understanding why certain interventions may be easier to implement in given populations, or why some interventions may show limited evidence of effectiveness. There is a large body of evidence relating to behavioural and psychosocial interventions for ALHIV; however, these studies rarely report on mental health outcomes specifically, often focusing on treatment adherence and sexual and reproductive health outcomes [34][35][36][37]. Existing interventions tend to be specifically designed to promote adherence to ART and prevent risky sexual behaviours such as unprotected intercourse [38], which are seen as essential to supporting adolescent health and preventing onward transmission.…”

Ways of coping mediate the relationship between self‐efficacy for managing HIV and acceptance of illness among people living with HIV

“…Adaptation to the new condition of living with HIV, manifesting as acceptance of illness (Samson & Siam, 2011), plays an important role in patients' subjective quality of life assessment (Mazurek & Lurbiecki, 2014). Additionally, previous studies have indicated that an increase in acceptance of HIV leads to improved adaptation outcomes, including ART adherence and better life quality (Kerrigan, Grieb, Ellen, & Sibinga, 2018; Oji et al., 2017); however, if PLWH lack illness acceptance, their lives with HIV may be hindered by a maladaptive state. Since little is known about the mechanisms contributing to illness acceptance among PLWH, it is important and necessary to further our understanding of these mechanisms to contribute to the development of reliable strategies for promoting positive adaptation outcomes.…”