AIDS and Behavior

, Volume 23, Issue 2, pp 459–474 | Cite as

The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study

  • Yusuf RansomeEmail author
  • Kenneth H. Mayer
  • Kiyomi Tsuyuki
  • Matthew J. Mimiaga
  • Carlos E. Rodriguez-Diaz
  • Kriengkrai Srithanaviboonchai
  • Ruth K. Friedman
  • Mohammed Limbada
  • Steven A. Safren
  • for the HIV Prevention Trials Network 063 Team
Original Paper


Early and sustained antiretroviral therapy (ART) adherence can suppress the HIV virus in individuals and reduce onward transmission of HIV in the population. Religiosity has been associated with better HIV clinical outcomes. Data are from a longitudinal, observational study of 749 HIV-infected individuals from Brazil, Zambia, and Thailand (HPTN 063). Ordered logistic regression assessed whether religious service attendance was associated with ART adherence (self-reported and plasma HIV-RNA) and moderated the association between alcohol problems and ART adherence. In each country, > 80% of participants reported high self-reported ART adherence (good/very good/excellent). Religious service attendance exceeded 85% but was statistically unrelated to adherence. In combined-country models, (p = 0.03) as alcohol problems increased, the probability of high self-reported ART adherence, as well as viral-load, became weaker at higher compared to low service attendance frequency. Future studies should evaluate spirituality variables and replicate the moderation analyses between religious attendance and alcohol problems.


Religion Antiretroviral therapy (ART) adherence HPTN Alcohol HIV/AIDS 


La adherencia temprana y sostenida a la terapia antirretroviral (TAR) puede suprimir el virus del VIH en los individuos y reducir la transmisión del VIH en la población. La religiosidad se ha asociado con mejores resultados clínicos del VIH. Los datos provienen de un estudio observacional longitudinal de 749 individuos infectados con VIH de Brasil, Zambia y Tailandia (HPTN 063). La regresión logística ordenada evaluó si la asistencia al servicio religioso estaba asociada con la adherencia al TAR (autoreportado y el ARN del VIH en plasma) y moderaba la asociación entre los problemas del alcohol y la adherencia al TAR. En cada país, > 80% de los participantes reportaron un alto cumplimiento autoreportado de ART (bueno/muy bueno/excelente). La asistencia al servicio religioso excedió el 85%, pero estadísticamente no estuvo relacionada con la adherencia. En los modelos de países combinados, (p = 0.03) a medida que aumentaban los problemas de alcohol, la probabilidad de una alta adherencia autoreportada al TAR, así como la carga viral, se debilitó a una frecuencia de asistencia más alta en comparación con la baja. Los estudios futuros deberían evaluar las variables de espiritualidad y reproducir los análisis de moderación entre asistencia religiosa y problemas con el alcohol.



Yusuf Ransome received funding from research grant from the National Institutes of Health/National Institute of Allergy and Infectious Diseases (Grant Number UM1 A1068619). HPTN 063 was funded by the Division of AIDS (DAIDS), National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH) under Cooperative Agreement # UM1AI068619. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or The HIV Prevention Trials Network. Steven A. Safren time was also supported by the National Institutes of Health (NIH) research Grant (9K24DA040489). Yusuf Ransome time was also supported by the National Institute of Mental Health research Grant (K01MH111374). Kiyomi Tsuyuki time was supported by the National Institute of Alcohol Abuse and Alcoholism (K01AA025009).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethnical considerations reviewed and approved by institutional review boards (IRB) within each recruitment country.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yusuf Ransome
    • 1
    • 2
    Email author
  • Kenneth H. Mayer
    • 3
    • 4
    • 5
  • Kiyomi Tsuyuki
    • 6
  • Matthew J. Mimiaga
    • 7
  • Carlos E. Rodriguez-Diaz
    • 8
  • Kriengkrai Srithanaviboonchai
    • 9
  • Ruth K. Friedman
    • 10
  • Mohammed Limbada
    • 11
  • Steven A. Safren
    • 12
  • for the HIV Prevention Trials Network 063 Team
  1. 1.Department of Social and Behavioral SciencesYale School of Public HealthNew HavenUSA
  2. 2.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.The Fenway Institute, Fenway HealthBostonUSA
  4. 4.Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA
  6. 6.Division of Global Public Health, School of MedicineUniversity of San DiegoSan DiegoUSA
  7. 7.Department of Social and Behavioral SciencesBrown University School of Public HealthProvidenceUSA
  8. 8.University of Puerto Rico School of Public HealthSan JuanUSA
  9. 9.Faculty of Medicine, and Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
  10. 10.Instituto de Pesquisa Clinica Evandro ChagasRio de JaneiroBrazil
  11. 11.ZambartLusakaZambia
  12. 12.Department of PsychologyUniversity of MiamiCoral GablesUSA

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