, Volume 12, Issue 1, pp 95-103
Date: 15 May 2007

Medication Adherence Mediates the Relationship between Adherence Self-efficacy and Biological Assessments of HIV Health among those with Alcohol Use Disorders

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The current study examines the relationship between negative consequences of alcohol use, adherence self-efficacy, medication adherence, and biological markers of HIV health (CD4 count and viral load). A total of 275 HIV-positive men and women with alcohol use disorders were surveyed using Audio-CASI measures and time line followback interviews. Findings from a structural equation model suggest that negative consequences related to alcohol use did not directly impact HIV health. Adherence self-efficacy had direct effects on viral load, but not CD4 count. Mediation analyses indicated that self-reported adherence partially mediated the relationship between adherence self-efficacy and viral load. Cognitive-oriented interventions aimed at facilitating adherence self-efficacy may be effective in improving both medication adherence and HIV health. If facilitating confidence improves HIV health, then health care providers can make a strong impact by spending a few short minutes themselves and/or partnering with behavioral health clinicians using techniques like motivational enhancement.

Project PLUS was supported by a grant from the National Institute of Alcohol Abuse and Alcoholism (RO1 AA13556, Jeffrey T. Parsons, Principal Investigator). The contributions of Dr. Rosof were supported through a postdoctoral fellowship in the Behavioral Sciences Training in Drug Abuse Research program sponsored by Medical and Health Research Association of New York City, Inc. and the National Development and Research Institutes (NDRI) with funding from the National Institute on Drug Abuse (5T32 DA07233). The authors acknowledge the contributions of the other members of the Project PLUS team: Catherine Holder, Jose Nanin, Bradley Thomason, Michael Adams, Christian Grov, Sarit Golub, James Kelleher, Lorelei Bonet, Juline Koken, Joseph C. Punzalan, and Chris Hietikko. We would also like to thank Kendall Bryant for his support of the project; all of the clinics and sites that provided access to potential participants; and two anonymous reviewers and Juline Koken for their suggestions regarding the manuscript.