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Pathways to Poor Adherence to Antiretroviral Therapy Among People Living with HIV: The Role of Food Insecurity and Alcohol Misuse

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Abstract

Daily adherence to antiretroviral therapy (ART) increases the length and quality of life of people living with HIV (PLHIV). We explored whether socioeconomic status directly impacts ART adherence and whether part of the effect is mediated by pathways through alcohol misuse or food insecurity. A cross-sectional study was conducted in Rio de Janeiro/Brazil (November/2019 to March/2020) with PLHIV aged ≥ 18 years. Validated instruments were used to measure alcohol use, food insecurity, and ART adherence. Using structural equation modeling we assessed the direct and indirect effects of variables on ART adherence. Participants reported significant challenges: hunger: 12%, alcohol use: 64%, and missing ART doses: 24%. Results showed that lower socioeconomic status increased poor adherence and that this effect was mediated through higher food insecurity. Alcohol misuse also increased poor adherence through a strong direct effect. Providing socio-economic support coupled with interventions to mitigate alcohol’s harmful impact can aid HIV care.

Resumen

La adherencia diaria a la terapia antirretroviral (TAR) aumenta la duración y calidad de vida de las personas que viven con el VIH (PVVIH). Exploramos si el estatus socioeconómico afecta directamente la adherencia al TAR y si parte del efecto está mediado por vías a través del abuso del alcohol o la inseguridad alimentaria. Se realizó un estudio en Río de Janeiro/Brasil (noviembre/2019 a marzo/2020) con PVVIH con edad ≥ 18 años. Utilizando modelos de ecuaciones estructurales evaluamos los efectos directos e indirectos. Los participantes informaron desafíos significativos: hambre: 12%, consumo de alcohol: 64%, mala adherencia: 24%. Los resultados mostraron que un nivel socioeconómico más bajo aumentaba la mala adherencia por un efecto mediado por mayor inseguridad alimentaria. Abuso de alcohol también aumentó la mala adherencia por un fuerte efecto directo. Brindar apoyo socioeconómico con intervenciones para mitigar el impacto nocivo del alcohol puede ayudar la atención clínica.

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Data Availability

All data from the current study were reported in the manuscript, tables, and supplementary material. The datasets generated during and/or analyzed during the current study are not publicly available. Data supporting the study findings are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

This research is supported by the NIH-funded Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA) (U01AI069923) and the Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz). HP acknowledges funding Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) (E-26/210.351/2021). BG acknowledges funding from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (305789/2019-8) and FAPERJ (E-26/202.915/2018). PML acknowledges funding from CNPq (316401/2021-8) and FAPERJ (E-26/201.133/2021). The funders had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil

    Hugo Perazzo, Juliana L. Gonçalves, Sandra W. Cardoso, Beatriz Grinsztejn, Valdilea G. Veloso & Paula M. Luz

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  1. Hugo Perazzo
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  2. Juliana L. Gonçalves
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  3. Sandra W. Cardoso
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  4. Beatriz Grinsztejn
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  5. Valdilea G. Veloso
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  6. Paula M. Luz
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Contributions

PML, HP, SWC, BG, and VGV conceived the study. PML, HP, JLG, SWC were responsible for data collection. JLG conducted all interviews. PML was responsible for data management and analysis. PML and HP wrote the first draft. All authors reviewed the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Paula M. Luz.

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Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board from Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ (IRB nº 3.507.370/2019). All participants signed an informed consent prior to enrollment in this study.

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Perazzo, H., Gonçalves, J.L., Cardoso, S.W. et al. Pathways to Poor Adherence to Antiretroviral Therapy Among People Living with HIV: The Role of Food Insecurity and Alcohol Misuse. AIDS Behav 28, 1173–1185 (2024). https://doi.org/10.1007/s10461-023-04141-w

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