Self-efficacy and depression as mediators of the relationship between pain and antiretroviral adherence

Abstract

The goals of this study were to examine the association between pain and antiretroviral adherence, and to estimate the mediating effect of adherence self-efficacy and depression symptom severity. Surveys using audio computer-assisted self-interview were conducted among 70 HIV-infected current and former drug users enrolled in a methadone program. We assessed antiretroviral adherence and adherence self-efficacy using questions from the Adult Clinical Trials Group survey. We considered participants adherent if they reported taking at least 95% of prescribed antiretrovirals over the past seven days. We assessed depression symptom severity using the depression subscale of the Brief Symptom Inventory. Participants reported pain of any duration in response to a question from the Brief Pain Inventory. Participants reporting pain were 87% less likely to be classified as adherent compared to those without pain [OR unadj = 0.13 (95%CI 0.03-0.52)]. When we examined adherence self-efficacy as a mediator of the relationship between pain and adherence, criteria for partial mediation were met. Adjusting for self-efficacy, the beta coefficient for pain decreased by 23% but the independent relationship between pain and antiretroviral adherence was maintained. Mediation criteria were not met when we examined the mediating effect of depression symptom severity on the relationship between pain and adherence. Adjusting for depression symptom severity, the beta coefficient for pain decreased by 9% and the relationship between pain and antiretroviral adherence remained significant. Our results indicate that neither adherence self-efficacy nor depression symptom severity fully mediated the relationship between pain and adherence. HIV providers should recognize the potential impact of pain on antiretroviral adherence among current and former drug users.

Self-efficacy, medication beliefs and adherence to antiretroviral therapy by patients attending a health facility in Pretoria

“…The mean adherence self-efficacy score of 6.45 out of a possible 10 compares well with a previous study by Berg et al 33 whereby the mean adherence self-efficacy was a moderate 1.81 on a scale of 0-3 in a study that sought to ascertain if self-efficacy and depression mediated the relationship between pain and adherence to ART in HIV-infected current and former drug users enrolled in a methadone programme in the USA. Within the context of adherence self-efficacy with respect to ART, patients who demonstrated sound confidence in carrying out the tasks were shown to adhere well to the treatment, and those with low …”

Pain and Mortality Risk in a Cohort of HIV-Infected Persons with Alcohol Use Disorders

“…Unlike as in some prior studies that reported associations between pain and adherence to HIV medications [36, 40], pain was not associated with ART use or HIV control. In the fully adjusted models, the only factors that were independently associated with mortality were HCV co-infection and low CD4 cell count, which are established risk factors for mortality among persons with HIV and alcohol use disorders [41].…”

Pain Treatment and Antiretroviral Medication Adherence Among Vulnerable HIV-Positive Patients

“…Although elevated with respect to the general population, this finding is in line with prior research on HIV-positive patients, which has gauged pain prevalence to be between 40% and 80%. [1][2][3][4] Our data confirm that pain is an exceedingly common co-morbid health condition among HIV-positive individuals, including the non-elderly and those treated in an era of ARVs with lower side effect profiles. Although this study did not gather information on pain intensity or duration, prescribed pharmacotherapy to treat pain was modest, with 41.5% of those endorsing pain being untreated.…”

“…10 Despite these challenges, balanced and appropriate pain management among vulnerable HIV patients is critical to both individual and public health. 7 A small but emerging body of literature suggests that pain experience among HIV-positive patients is associated with poor ARV adherence and reduced attendance at HIV-related care visits, 2,3,14 both of which are key behavioral components of disease management to achieve viral suppression and prevent onward transmission. 15,16 Although a handful of other studies has shown no link between pain and ARV treatment adherence, 1,13 the dearth of research on this topic precludes consensus.…”

“…[1][2][3][4] The etiology of pain among HIV-positive individuals is varied, and includes infection-related inflammatory responses, secondary complications of progressive HIV disease, as well as adverse effects of treatment with antiretroviral (ARV) medications. 5 Sensory neuropathy, for example, has been estimated to affect 40-60% of treated HIV-positive individuals, 6 and often results in moderate to severe pain.…”