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Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-Infected Individuals

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Abstract

Adherence to antiretroviral therapy (ART) among HIV-infected individuals is necessary to both individual and public health, and psychosocial problems have independently been associated with poor adherence. To date, studies have not systematically examined the effect of multiple, co-occurring psychosocial problems (i.e., “syndemics”) on ART adherence. Participants included 333 HIV-infected individuals who completed a comprehensive baseline evaluation, as part of a clinical trial to evaluate an intervention to treat depression and optimize medication adherence. Participants completed self-report questionnaires, and trained clinicians completed semi-structured diagnostic interviews. ART non-adherence was objectively measured via an electronic pill cap (i.e., MEMS). As individuals reported a greater number of syndemic indicators, their odds of non-adherence increased. Co-occurring psychosocial problems have an additive effect on the risk for poor ART adherence. Future behavioral medicine interventions are needed that address these problems comprehensively, and/or the core mechanisms that they share.

Resumen

Entre las personas VIH-positivas, adherencia a los tratamientos antirretrovirales (ART por sus siglas en inglés) es clave para la salud personal y la salud pública. Problemas psicosociales han sido independientemente asociados con un bajo nivel de adherencia. Estudios científicos aun no han examinado el impacto en la adherencia al ART dentro del contexto de coocurrencia de varios problemas psicosociales (“syndemics”). Personas VIH-positivas (N = 333) completaron una evaluación de línea base, como parte de su participación en un ensayo clínico donde el propósito fue examinar una intervención para el tratamiento de la depresión y mejoramiento de adherencia a los medicamentos. Los participantes completaron un autoinforme y también una entrevista diagnóstica semiestructurada. El nivel de adherencia al ART fue medido a través de un tapón de botella electrónica (sistema MEMS). Con cada indicador de “syndemics” que fue reportado por los participantes, sus probabilidades de no adhesión aumentaron. La coocurrencia de varios problemas psicosociales resultan en un impacto aditivo al riesgo de tener pobre adherencia al ART. Para enfrentar estos problemas de manera integral se necesita el desarrollo de intervenciones basadas en la medicina conductual y mejorar el entendimiento de los mecanismos fundamentales los cuales tienen en común.

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Acknowledgments

This research was supported by the National Institute of Mental Health, Grant R01MH084757, awarded to Dr. Steven A. Safren, NIMH K24MH094214 awarded to Dr. Safren, and NIMH K23MH096647 awarded to Dr. Aaron Blashill. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    Aaron J. Blashill, C. Andres Bedoya, Conall O’Cleirigh, Jocelyn E. Remmert & Steven A. Safren

  2. Harvard Medical School, Boston, MA, USA

    Aaron J. Blashill, C. Andres Bedoya, Kenneth H. Mayer, Conall O’Cleirigh & Steven A. Safren

  3. Fenway Institute, Boston, MA, USA

    Aaron J. Blashill, Kenneth H. Mayer, Conall O’Cleirigh, Matthew J. Mimiaga & Steven A. Safren

  4. Harvard School of Public Health, Boston, MA, USA

    Kenneth H. Mayer & Matthew J. Mimiaga

  5. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth H. Mayer

  6. Brown Medical School, Providence, RI, USA

    Megan M. Pinkston

  7. One Bowdoin Square, 7th Floor, Boston, 02114, MA, USA

    Aaron J. Blashill

  8. The Miriam Hospital, Providence, RI, USA

    Megan M. Pinkston

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  1. Aaron J. Blashill
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Correspondence to Aaron J. Blashill.

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Blashill, A.J., Bedoya, C.A., Mayer, K.H. et al. Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-Infected Individuals. AIDS Behav 19, 981–986 (2015). https://doi.org/10.1007/s10461-014-0925-6

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  • DOI: https://doi.org/10.1007/s10461-014-0925-6

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