Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa

ABSTRACT

First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05–1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29–0.87]), higher social isolation (0.93 [0.87–0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86–1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.

KEYWORDS:

• Highly active antiretroviral therapy
• medication adherence
• substance abuse
• social support systems
• social isolation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Mental Health [grant number P30MH043520, R01MH095576, T32MH019139]; National Institute on Drug Abuse [grant number K01DA044853].