Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 7/2017

01-07-2017 | Original Paper

Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa

Authors: Connie T. Kekwaletswe, Esmé Jordaan, Sebenzile Nkosi, Neo K. Morojele

Published in: AIDS and Behavior | Issue 7/2017

Login to get access

Abstract

We sought to (a) replicate and (b) extend (via the addition of alcohol use) Cha et al.’s cross-sectional multi-component model of ART adherence on the relationship between social support, depression, self-efficacy beliefs, and antiretroviral therapy (ART) adherence, among HIV patients in Tshwane, South Africa. Using purposive sampling, 304 male and female ART recipients were recruited. ART adherence was assessed using three manifest indicators: total adherence ratio, the CASE adherence index and 1-month adherence measure. Data were analysed using structural equation modeling. In our replicated model, social support had both direct and indirect relationships with ART adherence, and inclusion of alcohol use improved prediction of ART adherence. Direct and indirect effects of alcohol use on ART adherence emerged: adherence self-efficacy beliefs partially mediated the latter path. Findings highlight the importance of integrating into ART promotion interventions, the reduction of alcohol use, provision of social support, and enhancement of adherence self-efficacy beliefs.
Appendix
Available only for authorised users
Literature
1.
UNAIDS. UNAIDS report on the global AIDS epidemic 2013. Geneva: Author; 2013.
2.
Larson E, Bendavid E, Tuoane-Nkhasi M, Mbengashe T, Goldman T, Wilson M, et al. Population-level associations between antiretroviral therapy scale-up and all-cause mortality in South Africa. Int J STD AIDS. 2013;25(9):636–42.CrossRefPubMed
3.
4.
WHO. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: Author; 2015.
5.
Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):e438.CrossRefPubMedPubMedCentral
6.
Amberbir A, Woldemichael K, Getachew S, Girma B, Deribe K. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia. BMC Public Health. 2008;8(265).
7.
Carrieri P, Cailleton V, Le Moing V, Spire B, Dellamonica P, Bouvet E, et al. The dynamic of adherence to highly active antiretroviral therapy: results from the French National APROCO cohort. J Acquir Immune Defic Syndr. 2001;28:232–9.CrossRefPubMed
8.
Grierson J, Koelmeyer RL, Smith A, Pitts M. Adherence to antiretroviral therapy: factors independently associated with reported difficulty taking antiretroviral therapy in a national sample of HIV-positive Australians. HIV Med. 2011;12(9):562–9.CrossRefPubMed
9.
Byakika-Tusiime J, Crane J, Oyugi JH, Ragland K, Kawuma A, Musoke P, et al. Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13:82–91.CrossRefPubMed
10.
Genberg BL, Lee Y, Rogers WH, Wilson IB. Four types of barriers to adherence of antiretroviral therapy are associated with decreased adherence over time. AIDS Behav. 2015;19(1):85–92.CrossRefPubMedPubMedCentral
11.
Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112:178–93.CrossRefPubMedPubMedCentral
12.
Binford MC, Kahana SY, Altice FL. A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs. Curr HIV/AIDS Rep. 2012;9:287–312.CrossRefPubMed
13.
Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180–202.CrossRefPubMedPubMedCentral
14.
Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–18.CrossRefPubMed
15.
Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review—alcohol and the HIV continuum of care. Curr HIV/AIDS Rep. 2015; 12(4):421–36.
16.
WHO. Global status report on alcohol and health 2014. Geneva: Author; 2014.
17.
Parry CDH, Kekwaletswe C, Shuper PA, Nkosi S, Myers BJ, Morojele N. Heavy alcohol use in patients on highly active antiretroviral therapy: what responses are needed? S Afr Med J. 2016;106(6):567–8.CrossRef
18.
Huis In ‘t Veld D, Pengpid S, Colebunders R, Skaal L, Peltzer K. High-risk alcohol use and associated socio-demographic, health, and psychosocial factors in patients with HIV infection in three primary health care clinics in South Africa. Int J STD AIDS. 2016; July 21 (Epub ahead of print).
19.
Cha E, Erlen JA, Kim KH, Sereika SM, Caruthers D. Mediating roles of medication-taking self-efficacy and depressive symptoms on self-reported medication adherence in persons with HIV: a questionnaire survey. Int J Nurs Stud. 2008;45(8):1175–84.CrossRefPubMed
20.
DiIorio C, McCarty F, DePadilla L, Resnicow K, Holstad MM, Yeager K, et al. Adherence to antoretroviral medication regimens: a test of a psychosocial model. AIDS Behav. 2009;13(1):10–22.CrossRefPubMed
21.
Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74–81.CrossRefPubMedPubMedCentral
22.
Woodward EN, Pantalone DW. The role of social support and negative affect in medication adherence for HIV-infected men who have sex with men. J Assoc Nurses AIDS Care. 2012;23(5): 388-96.
23.
Ware NC, Idoko J, Kaaya S, Biraro IA, Wyatt MA, Oche Agbaji O, et al. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Med. 2009;6(1):e1000011.CrossRefPubMedCentral
24.
O’Laughlin KN, Wyatt MA, Kaaya S, Bangsberg DR, Ware NC. How treatment partners help: social analysis of an African adherence support intervention. AIDS Behav. 2012;16(5):1308–15.CrossRefPubMed
25.
26.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRef
27.
Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA. The predictive value of self report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int. 2006;69:1662–8.CrossRefPubMed
28.
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders screening test (AUDIT). WHO collaborative project on early detection of persons with harmful alcohol consumption. II. Addiction. 1993;88:791–804.
29.
Johnson MO, Neilands TB, Dilworth S, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV treatment adherence self-efficacy scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.CrossRefPubMedPubMedCentral
30.
Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient care committee & adherence working group of the outcomes Committee of the adult AIDS clinical trials group (AACTG). AIDS Care. 2000;12:255–66.CrossRefPubMed
31.
Reynolds NR, Sun J, Nagaraja HN, Gifford AL, Wu AW, Chesney MA. Optimizing measurement of adherence of self-reported adherence with ACTG adherence questionnaire: a cross-protocol analysis. J Acquir Immune Defic Syndr. 1997;46(4):402–9.CrossRef
32.
Mannheimer SB, Mukherjee R, Hirschhorn LR, Dougherty J, Celano SA, Ciccarone D, et al. The case adherence index: a novel method for measuring adherence to antiretroviral therapy. AIDS Care. 2006;18(7):853–61.CrossRefPubMedPubMedCentral
33.
Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86–94.CrossRefPubMed
34.
Muthén LK, Muthén BO. Mplus User’s Guide. Los Angeles: Muthén & Muthén; 1998–2014.
35.
Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55.CrossRef
36.
Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973;38(1):1–10.CrossRef
37.
Byrne BM. Structural equation modeling with LISREL, PRELIS and SIMPLIS: basic concepts, applications and programming. Mahwah: Lawrence Erlbaum Associates; 1998.
38.
Cai L, Maydeu-Olivares A, Coffman DL, Thissen D. Limited information goodness of fit testing of item response theory models for sparse 2p tables. Br J Math Stat Psychol. 2006;59:173–94.CrossRefPubMed
39.
Kline RB. Principles and practice of structural equation modeling. New York: Guilford Press; 1998.
40.
Comrey AL, Lee HB. A first course in factor analysis. Hillsdale: Erlbaum; 1992.
41.
Kalichman SC, Amaral CM, White D, Swetsze C, Kalichman MO, Cherry C, et al. Alcohol and adherence to antiretroviral medications: interactive toxicity beliefs among people living with HIV. J Assoc Nurses AIDS Care. 2012;23(6):511–20.CrossRefPubMedPubMedCentral
42.
Kalichman SC, Amaral CM, White D, Swetsze C, Pope H, Kalichman MO, et al. Prevalence and clinical implications of interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV/AIDS. AIDS Patient Care STDs. 2009;23:449–54.CrossRefPubMedPubMedCentral
43.
Kalichman SC, Grebler T, Amaral CM, McNerey M, White D, Kalichman MO, et al. Intentional non-adherence to medications among HIV positive alcohol drinkers: prospective study of interactive toxicity beliefs. J Gen Intern Med. 2013;28(3):399–405.CrossRefPubMed
44.
Rosof EJ, Punzalan JC, Parsons JT. Adherence: how alcohol gets in the way. Elements of success: an International Conference on Adherence to Antiretroviral Therapy; Dallas, TX2004.
45.
Huynh AK, Kinsler JJ, Cunningham WE, Sayles JN. The role of mental health in mediating the relationship between social support and optimal ART adherence. AIDS Care. 2013;25(9):1179–84.CrossRefPubMedPubMedCentral
46.
Brown JL, Littlewood RA, Vanable PA. Social-cognitive correlates of antiretroviral therapy adherence among HIV-infected individuals receiving infectious disease care in a medium-sized northern U.S. city. AIDS Care. 2013;25(9):1149–58.CrossRefPubMedPubMedCentral
47.
Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Improving clinic attendance and adherence to antiretroviral therapy through a treatment supporter intervention in Uganda: a randomized controlled trial. AIDS Behav. 2011;15(8):1795–802.CrossRefPubMed
48.
Duwell MM, Knowlton AR, Nachega JB, Efron A, Goliath R, Morroni C, et al. Patient-nominated, community-based HIV treatment supporters: patient perspectives, feasibility, challenges, and factors for success in HIV-infected South African adults. AIDS Patient Care STDs. 2013;27(2):96–102.CrossRefPubMedPubMedCentral
49.
Nachega JB, Hislop M, Dowdy DW, Lo M, Omer SB, Regensberg L, et al. Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults. J Acquir Immune Defic Syndr. 2006;43(1):78–84.CrossRefPubMed
50.
Scanlon ML, Vreeman RC. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings. HIV AIDS (Auckl). 2013;5:1–17.PubMedPubMedCentral
51.
Hussong AM. Further refining the stress-coping model of alcohol involvement. Addict Behav. 2003;28:1515–22.CrossRefPubMed
52.
Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142.CrossRefPubMedPubMedCentral
53.
Kekwaletswe CT, Morojele NK. Patterns and predictors of antiretroviral therapy use among alcohol drinkers at HIV clinics in Tshwane, South Africa. AIDS Care. 2014;26(Suppl 1):S78–82.CrossRefPubMed
54.
Sankar A, Wunderlich T, Neufeld S, Luborsky M. Sero-positive African American’s beliefs about alcohol and their impact on anti-retroviral adherence. AIDS Behav. 2007;11(2):195–203.CrossRefPubMedPubMedCentral
55.
MacCallum RC, Austin JT. Applications of structural equation modeling in psychological research. Annu Rev Psychol. 2000;51:201–26.CrossRefPubMed
56.
MacCallum RC, Wegener DT, Uchino BN, Fabrigar LR. The problem of equivalent models in applications of covariance structure analysis. Psychol Bull. 1993;114(1):185–99.CrossRefPubMed
57.
Dlamini PS, Wantland D, Makoae LN, Chirwa M, Kohi TW, Greeff M, et al. HIV stigma and missed medications in HIV-positive people in five African Countries. AIDS Patient Care STDs. 2009;23(5):377–87.CrossRefPubMedPubMedCentral
58.
Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711–6.CrossRefPubMedPubMedCentral
59.
Coetzee B, Kagee A, Vermeulen N. Structural barriers to adherence to antiretroviral therapy in a resource-constrained setting: the perspectives of health care providers. AIDS Care. 2011;23(2):146–51.CrossRefPubMed
60.
Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Glob Public Health. 2011;6(1):83–97.CrossRefPubMedPubMedCentral
61.
Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, et al. South African National HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press; 2014.
62.
Johnson LF. Access to antiretroviral treatment in South Africa, 2004-2011. S Afr J HIV Med. 2012;13(1):22–7.CrossRef
Metadata
Title
Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa
Authors
Connie T. Kekwaletswe
Esmé Jordaan
Sebenzile Nkosi
Neo K. Morojele
Publication date
01-07-2017
Publisher
Springer US
Published in
AIDS and Behavior / Issue 7/2017
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-016-1595-3

Other articles of this Issue 7/2017

AIDS and Behavior 7/2017 Go to the issue

Original Paper

First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania

Original Paper

Concordance Between Self-Report and Performance-Based Measures of Everyday Functioning in HIV-Associated Neurocognitive Disorders

Substantive Review

Theoretical and Empirical Comparisons of Methods to Estimate the Size of Hard-to-Reach Populations: A Systematic Review

Original Paper

Objective Measurement of Inaccurate Condom Use Reporting Among Women Using Depot Medroxyprogesterone Acetate for Contraception

Substantive Review

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

Original Paper

Direct and Indirect Effects of Heavy Alcohol Use on Clinical Outcomes in a Longitudinal Study of HIV Patients on ART

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits