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.

KEYWORDS:

• HIV
• youth
• stigma
• adherence
• mindfulness

Acknowledgments

We would like to thank the study participants for their time and commitment, as well as, the UMMC site-PI Vicki Tepper, PhD; project staff -- Tracey Chambers Thomas, Jan Stevenson, and Lindsey Webb; MBSR instructors -- Tawanna Kane and Mira Tessman; and Health education instructors -- McCay Moiforay and Keyya Simmons.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Center for Complementary and Integrative Health [grant number R01AT007888]; National Institute of Allergy and Infectious Diseases [grant number P30AI094189]; Johns Hopkins University Center for AIDS Research [grant number 1P30AI094189].