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Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV

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Abstract

Depression is a known risk factor for antiretroviral therapy (ART) non-adherence, but little is known about the mechanisms explaining this relationship. Identifying these mechanisms among people living with HIV (PLHIV) after release from prison is particularly important, as individuals during this critical period are at high risk for both depression and poor ART adherence. 347 PLHIV recently released from prison in North Carolina and Texas were included in analyses to assess mediation of the relationship between depressive symptoms at 2 weeks post-release and ART adherence (assessed by unannounced telephone pill counts) at weeks 9–21 post-release by the hypothesized explanatory mechanisms of alcohol use, drug use, adherence self-efficacy, and adherence motivation (measured at weeks 6 and 14 post-release). Indirect effects were estimated using structural equation models with maximum likelihood estimation and bootstrapped confidence intervals. On average, participants achieved 79% ART adherence. The indirect effect of depression on adherence through drug use was statistically significant; greater symptoms of depression were associated with greater drug use, which was in turn associated with lower adherence. Lower adherence self-efficacy was associated with depressive symptoms, but not with adherence. Depression screening and targeted mental health and substance use services for depressed individuals at risk of substance use constitute important steps to promote adherence to ART after prison release.

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Acknowledgements

This research was supported by the National Institute on Drug Abuse (R01 DA030793) and the UNC Center for AIDS Research (P30 AI50410). This research was partially supported by a National Research Service Award Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill (T32 HS000032). Dr. Golin’s salary was partially supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24 HD069204). Dr. Wohl’s salary (K24 DA037101) and Dr. Gottfredson’s salary (K01 DA035153) were partially supported by the National Institute on Drug Abuse. 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. Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lauren M. Hill, Carol E. Golin, Nisha C. Gottfredson & Jessica Carda-Auten

  2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lauren M. Hill, Carol E. Golin & Jennifer S. Groves

  3. Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Carol E. Golin, Sonia Napravnik & David Wohl

  4. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Brian W. Pence, Bethany DiPrete & Sonia Napravnik

  5. Department of Psychology, Texas Christian University, Fort Worth, TX, USA

    Kevin Knight & Patrick M. Flynn

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Hill, L.M., Golin, C.E., Gottfredson, N.C. et al. Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV. AIDS Behav 23, 2037–2047 (2019). https://doi.org/10.1007/s10461-018-2355-3

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