Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care

Satyanarayana, Satyanand; Rogers, Brooke G.; Bainter, Sierra A.; Christopoulos, Katerina; Fredericksen, Rob J.; Mathews, W. Christopher; Moore, Richard D.; Mugavero, Michael J.; Napravnik, Sonia; Mimiaga, Matthew J.; Mayer, Kenneth H.; Crane, Heidi M.; Safren, Steven A.

doi:10.1089/apc.2021.0004

Cited by 10 publications

(3 citation statements)

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“…The main strength of our study is the application of syndemic theory to understand the impact of psychosocial factors on ART adherence. Previous studies showed that more syndemic psychosocial factors were associated with lower ART adherence among PLHIV [ 14 , 16 , 62 ]. When examining the relationship between the number of psychosocial factors and ART adherence, it was assumed that the effects of each psychosocial factor were equal.…”

Section: Discussionmentioning

confidence: 99%

“…Among the factors associated with ART adherence, psychosocial factors, including beliefs about ART, self-efficacy, social support, social capital, depression, HIV-related stigma, etc., could be targeted as modifiable factors for interventions to improve ART adherence and are receiving increasing attention. However, psychosocial factors are more likely to coexist and may interact with each other to influence ART adherence, which could be addressed by applying syndemic theory [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies showed that more syndemic factors (including depression, HIV-related stigma, substance use, violence, etc.) were associated with a higher risk of suboptimal ART adherence [14][15][16][17][18]. However, the additive associations of different syndemic factors with ART adherence may not actually explain the effects of interactions between the syndemic factors on ART adherence and may provide limited guidance for intervention efforts [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with antiretroviral treatment adherence among people living with HIV in Guangdong Province, China: a cross sectional analysis

Liu,

Yan,

et al. 2024

BMC Public Health

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Background Understanding factors associated with antiretroviral treatment (ART) adherence is crucial for ART success among people living with HIV (PLHIV) in the “test and treat” era. Multiple psychosocial factors tend to coexist and have a syndemic effect on ART adherence. We aimed to explore factors associated with ART adherence and the syndemic effect of multiple psychosocial factors on ART adherence among PLHIV newly starting ART in Guangdong Province, China. Methods Newly diagnosed PLHIV from six cities in Guangdong Province were recruited between May 2018 and June 2019, and then followed up from May 2019 to August 2020. Baseline and follow-up data were collected from a questionnaire and the national HIV surveillance system, the follow-up data of which were analyzed in this study. A Center for Adherence Support Evaluation (CASE) index > 10 points was defined as optimal ART adherence, which was measured via participants’ self-reported adherence during follow-up survey. Multivariable logistic regression was used to identify factors associated with ART adherence. Exploratory factor analysis (EFA) and multi-order latent variable structural equation modeling (SEM) were performed to explore the syndemic effect of multiple psychosocial factors on ART adherence. Results A total of 734 (68.53%) follow-up participants were finally included in this study among the 1071 baseline participants, of whom 91.28% (670/734) had self-reported optimal ART adherence. Unemployment (aOR = 1.75, 95%CI: 1.01–3.02), no medication reminder (aOR = 2.28, 95%CI: 1.09–4.74), low medication self-efficacy (aOR = 2.28, 95%CI: 1.27–4.10), low social cohesion (aOR = 1.82, 95%CI: 1.03–3.19), no social participation (aOR = 5.65, 95%CI: 1.71–18.63), and ART side effects (aOR = 0.46, 95%CI: 0.26–0.81) were barriers to optimal ART adherence. The EFA and second-order latent variable SEM showed a linear relationship (standardized coefficient = 0.43, P < 0.001) between ART adherence and the latent psychosocial (syndemic) factor, which consisted of the three latent factors of medication beliefs and self-efficacy (standardized coefficient = 0.65, P < 0.001), supportive environment (standardized coefficient = 0.50, P < 0.001), and negative emotions (standardized coefficient=-0.38, P < 0.01). The latent factors of medication beliefs and self-efficacy, supportive environment, and negative emotions explained 42.3%, 25.3%, and 14.1% of the variance in the latent psychosocial factor, respectively. Conclusions About nine out of ten PLHIV on ART in Guangdong Province self-reported optimal ART adherence. However, more efforts should be made to address barriers to optimal ART adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%