Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV

Abstract

Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease progression and reducing secondary HIV transmission, yet youth living with HIV (YLH) struggle with adherence. The highest rates of new HIV infections in the United States occur in young African American men. A sample of 387 HIV-positive young African American males on ART was selected from a cross-sectional assessment of (YLH) receiving medical care within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median 22.00, SD 2.08). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Sixtytwo percent self-reported 100% ART adherence. Optimal data analysis identified frequency of cannabis use during the past 3 months as the strongest independent predictor of adherence, yielding moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants with infrequent cannabis use, 72% reported full adherence; in contrast, only 45% of participants who used cannabis frequently reported full adherence. Classification tree analysis (CTA) was utilized to improve classification accuracy and to identify the pathways of ART adherence and nonadherence. The CTA model evidenced a 38% improvement above chance for correctly classifying participants as ART adherent or nonadherent. Participants most likely to be adherent were those with low psychological distress and minimal alcohol use (82% were adherent). Participants least likely to be adherent were those with higher psychological distress and engaged in weekly cannabis use (69% were nonadherent). Findings suggest multiple profiles of ART adherence for young African American males living with HIV and argue for targeted psychosocial interventions.

Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: An Integrative Review

“…These findings are consistent with evidence from a large multi-site study, demonstrating that adolescent and young adult participants least likely to be adherent had higher psychological distress and used marijuana weekly. More specifically, a frequency of substance use variable, marijuana use during the past 3 months, was the strongest independent predictor of ART adherence, yielding moderate effect strength sensitivity [6]. There is also compelling evidence to show that as the number of psychosocial conditions increases, there is a decreased likelihood of ART adherence [69].…”

“…Staggering disparities along the HIV care cascade exist for HIV-infected youth living in the US including lack of sustained HIV RNA viral suppression, adherence to antiretroviral therapy (ART), and retention in care [3, 4]. Antiretroviral therapy is recommended for all HIV-infected individuals irrespective of HIV biomarkers [5], and optimal HIV disease management is contingent upon high levels of adherence, greater than >95% to prescribed unboosted protease inhibitor (PI) containing ART regimens, and 80% adherence for boosted PI ART regimens [6, 7]. However, despite the availability of effective ART, estimates of HIV RNA viral suppression range from 30.5% [4] to less than six percent among HIV-infected youth [3], and uncontrolled HIV replication imposes an increased risk of morbidity and mortality at all CD4-T lymphocyte strata [8].…”

Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015

“…6,22,31,34,35 A recent study found that black adolescents and young adults with HIV who had higher psychological distress and reported higher frequency of cannabis use were less likely to be adherent to antiretroviral treatment. 36 It is possible that this and other factors may be driving the association between age and viral suppression.…”

The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review

“…This relationship has also been further explored among HIV-infected Black adolescents and young adults, where a high level of psychological distress and marijuana use weekly or more frequently for at least 3 months were predictive of ART non-adherence [69% accuracy; 30]. Further, 24% more of these high distress, frequent marijuana using youth were ARV non-adherent when comparing levels of reported self-efficacy to attend appointments, with high-self efficacy being protective.…”

“…HIV-infected individuals may use marijuana to mediate HIV symptoms and medication side effects [39, 42, 43], and users have been shown to be more likely to be avoidant, avoid stressors, and negative experiences [44] which may contribute to medication non-adherence. Further, while substance use has consistently been shown to impact ARV adherence, there may be attributes of use (e.g., frequency) or treatment adherence (e.g., self-efficacy), as demonstrated by Gross and colleagues [30], that may be stronger predictors of associations between medication adherence and marijuana use.…”