Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety

  • Gabriel J. CulbertEmail author
  • Agung Waluyo
  • Melinda Wang
  • Tissa Aulia Putri
  • Alexander R. Bazazi
  • Frederick L. Altice
Original Paper


With adequate support, people with HIV (PWH) may achieve high levels of adherence to antiretroviral therapy (ART) during incarceration. We examined factors associated with ART utilization and adherence among incarcerated PWH (N = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2–24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2–12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7–6.2, p < 0.001), and perceived need for medical treatment (aOR = 1.6, 95% CI 1.1–2.5, p = 0.011), and negatively associated with chance locus of control (aOR = 0.3, 95% CI 0.1–0.7, p = 0.013). Most participants utilizing ART (74.5%) reported less than “perfect” ART adherence. ART adherence was independently associated with perceived personal safety (β = 0.21, 95% CI 0.01–0.40, p = 0.032) and methadone utilization (β = 0.84, 95% CI 0.10–1.67, p = 0.047). PWH receiving methadone had a sixfold higher adjusted odds of being highly-adherent to ART (aOR = 6.3, 95% CI 1.1–35.7, p = 0.036). Interventions that increase methadone utilization and personal safety may improve ART adherence among incarcerated PWH.


Adherence Antiretroviral therapy HIV Methadone Prisons Substance use 



We thank study participants for generously sharing of their time and gratefully acknowledge operational assistance from the Directorate General of Corrections, Republic of Indonesia. We thank Abbott laboratories (formerly Alere) for equipment donated to the study.


This study was supported by NIH awards for research training (NIDA K23 DA041988 to GJC) and career development (NIDA K24 DA017072 to FLA).

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

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


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

Authors and Affiliations

  1. 1.Department of Health Systems Science, College of NursingUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Center for HIV/AIDS Nursing Research, Faculty of NursingUniversitas IndonesiaDepokIndonesia
  3. 3.Department of Medicine, Section of Infectious Diseases, AIDS ProgramYale University School of MedicineNew HavenUSA
  4. 4.Department of Psychiatry, San Francisco School of MedicineUniversity of CaliforniaSan FranciscoUSA
  5. 5.Department of Epidemiology of Microbial DiseasesYale University School of Public HealthNew HavenUSA
  6. 6.Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia

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