Journal of Religion and Health

, Volume 56, Issue 6, pp 2144–2161 | Cite as

Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates

  • Safiya George Dalmida
  • Katryna McCoy
  • Harold G. Koenig
  • Aretha Miller
  • Marcia McDonnell Holstad
  • Tami Thomas
  • Dora Clayton-Jones
  • Mary Grant
  • Terri Fleming
  • Menka Munira Wirani
  • George Mugoya
Original Paper

Abstract

Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (<90–95%) contributes to antiretroviral resistance and worse medical outcomes, including more rapid progression to AIDS and death. Psychosocial factors and religion/spirituality (R/S) have a significant impact on ART adherence, but the findings are mixed. The purpose of this study was to examine religious and psychosocial correlates and predictors of ≥90% ART adherence in PLWH. A cross-sectional study was conducted with a sample of 292 outpatient PLWH in the Southeastern USA. Participants completed computerized surveys. The mean ART adherence percentage was 80.9% and only about half reported ≥90% adherence. There were statistically significant differences in ART adherence rates based on age, depressive symptom status and frequency of religious attendance and prayer. Praying at least once a day was significantly associated with ≥90% ART adherence (OR = 2.26, 95% CI [1.06–4.79], p < 0.05). Social support satisfaction was also significantly associated with ART adherence (OR = 1.52, 95% CI [1.11–2.08], p < 0.05) and energy/fatigue/vitality (OR = 1.03, 95% CI [1.00–1.05], p < 0.05).

Keywords

HIV/AIDS Medication adherence Religion Spirituality Antiretroviral therapy 

References

  1. Bader, A., Kremer, H., Erlich-Trungenberger, I., Rojas, R., Lohmann, M., Deobald, O., et al. (2006). An adherence typology: Coping, quality of life, and physical symptoms of people living with HIV/AIDS and their adherence to antiretroviral treatment. Medical Science Monitor, 12(12), CR493–CR500.PubMedGoogle Scholar
  2. Balbin, E. G., Ironson, G. H., & Solomon, G. F. (1999). Stress and coping: The psychoneuroimmunology of HIV/AIDS. Best Practice & Research Clinical Endocrinology & Metabolism, 13(4), 615–633.CrossRefGoogle Scholar
  3. Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. A., Roberston, M., Zolopa, A. R., et al. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. Aids, 15(9), 1181–1183.CrossRefPubMedGoogle Scholar
  4. Bosworth, H. B. (2006). The importance of spirituality/religion and health-related quality of life among individuals with HIV/AIDS. Journal of General Internal Medicine, 21(S5), S3–S4.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Castro, K. G., Ward, J. W., Slutsker, L., Buehler, J. W., Jaffe, H. W., Berkelman, R. L., et al. (1993). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Clinical Infectious Diseases, 17(4), 802–810.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (2012). CDC Fact Sheet. HIV in the United States: The Stages of Care. Retrieved from www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf.
  7. Chavez, M. (2010). Rain dances in the dry season: Overcoming the religious congruence fallacy. Journal for the Scientific Study of Religion, 49(1), 1–14.CrossRefGoogle Scholar
  8. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 28(4), 385–396.CrossRefGoogle Scholar
  9. Dalmida, S. G. (2006). Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: Integrating spirituality into mental health care. Issues Ment Health Nurs, 27(2), 185–198. doi:10.1080/01612840500436958.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Dalmida, S. G., Holstad, M. M., Diiorio, C., & Laderman, G. (2009). Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS. Women and Health, 49(2–3), 119–143. doi:10.1080/03630240902915036.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Dalmida, S. G., Holstad, M. M., Diiorio, C., & Laderman, G. (2011). Spiritual well-being and health-related quality of life among african-american women with HIV/AIDS. Applied Research in Quality of Life, 6(2), 139–157. doi:10.1007/s11482-010-9122-6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Eaton, J. W., Johnson, L. F., Salomon, J. A., Barnighausen, T., Bendavid, E., Bershteyn, A., et al. (2012). HIV treatment as prevention: Systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Medicine, 9(7), e1001245. doi:10.1371/journal.pmed.1001245.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Finocchario-Kessler, S., Catley, D., Berkley-Patton, J., Gerkovich, M., Williams, K., Banderas, J., et al. (2011). Baseline predictors of ninety percent or higher antiretroviral therapy adherence in a diverse urban sample: The role of patient autonomy and fatalistic religious beliefs. AIDS Patient Care STDS, 25(2), 103–111.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Fogarty, L., Roter, D., Larson, S., Burke, J., Gillespie, J., & Levy, R. (2002). Patient adherence to HIV medication regimens: A review of published and abstract reports. Patient Education and Counseling, 46(2), 93–108.CrossRefPubMedGoogle Scholar
  15. Gardner, E. M., Sharma, S., Peng, G., Hullsiek, K. H., Burman, W. J., Macarthur, R. D., et al. (2008). Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. Aids, 22(1), 75–82. doi:10.1097/QAD.0b013e3282f366ff.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011a). Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 58(2), 181–187. doi:10.1097/QAI.0b013e31822d490a.CrossRefPubMedGoogle Scholar
  17. Gonzalez, J. S., Psaros, C., Batchelder, A., Applebaum, A., Newville, H., & Safren, S. A. (2011b). Clinician-assessed depression and HAART adherence in HIV-infected individuals in methadone maintenance treatment. Annals of Behavioral Medicine, 42(1), 120–126. doi:10.1007/s12160-011-9268-y.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Harding, R., Lampe, F. C., Norwood, S., Date, H. L., Clucas, C., Fisher, M., et al. (2010). Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sexually Transmitted Infections, 86(7), 520–524. doi:10.1136/sti.2009.038505.CrossRefPubMedGoogle Scholar
  19. Hays, R. D., Sherbourne, C. D., & Mazel, R. M. (1993). The RAND 36-Item health survey 1.0. Health Economics, 2(3), 217–227.CrossRefPubMedGoogle Scholar
  20. Hinkin, C. H., Hardy, D. J., Mason, K. I., Castellon, S. A., Durvasula, R. S., Lam, M. N., et al. (2004). Medication adherence in HIV-infected adults: Effect of patient age, cognitive status, and substance abuse. Aids, 18(Suppl1), S19–S25.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Holstad, M. M., Foster, V., Diiorio, C., McCarty, F., & Teplinskiy, I. (2010). An examination of the psychometric properties of the Antiretroviral General Adherence Scale (AGAS) in two samples of HIV-infected individuals. Journal of the Association of Nurses in AIDS Care, 21(2), 162–172. doi:10.1016/j.jana.2009.08.002.CrossRefPubMedGoogle Scholar
  22. Holstad, M. K., Pace, J. C., De, A. K., & Ura, D. R. (2006). Factors associated with adherence to antiretroviral therapy. Journal of the Association of Nurses in AIDS Care, 17(2), 4–15.CrossRefPubMedGoogle Scholar
  23. Institute, Fetzer. (1999). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo, MI: John E. Fetzer Institute.Google Scholar
  24. Ironson, G., Stuetzle, R., & Fletcher, M. A. (2006). An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. Journal of General Internal Medicine, 21(Suppl 5), S62–S68. doi:10.1111/j.1525-1497.2006.00648.x.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Kaldjian, L. C., Jekel, J. F., & Friedland, G. (1998). End-of-life decisions in HIV-positive patients: The role of spiritual beliefs. AIDS, 12(1), 103–107.CrossRefPubMedGoogle Scholar
  26. Kisenyi, R. N., Muliira, J. K., & Ayebare, E. (2013). Religiosity and adherence to antiretroviral therapy among patients attending a public hospital-based HIV/AIDS clinic in Uganda. Journal of Religion and Health, 52(1), 307–317.CrossRefPubMedGoogle Scholar
  27. Koenig, H. G. (1998). Religious attitudes and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry, 13(4), 213–224.CrossRefPubMedGoogle Scholar
  28. Koenig, H., & Cohen, H. J. E. (2002). The link between religion and health: Psychoneuroimmunology and the faith factor. Oxford: Oxford University Press.CrossRefGoogle Scholar
  29. Koenig, H. G., George, L. K., & Siegler, I. C. (1988). The use of religion and other emotion-regulating coping strategies among older adults. Gerontologist, 28(3), 303–310.CrossRefPubMedGoogle Scholar
  30. Konkle-Parker, D. J., Erlen, J. A., & Dubbert, P. M. (2008). Barriers and facilitators to medication adherence in a southern minority population with HIV disease. Journal of the Association of Nurses in AIDS Care, 19(2), 98–104.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Kremer, H., Ironson, G., & Porr, M. (2009). Spiritual and mind–body beliefs as barriers and motivators to HIV-treatment decision-making and medication adherence? A qualitative study. AIDS Patient Care STDS, 23(2), 127–134.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Kremer, H., Ironson, G., Schneiderman, N., & Hautzinger, M. (2006). To take or not to take: Decision-making about antiretroviral treatment in people living with HIV/AIDS. AIDS Patient Care & STDs, 20(5), 335–349.CrossRefGoogle Scholar
  33. Liu, H., Miller, L. G., Hays, R. D., Golin, C. E., Wu, T., Wenger, N. S., et al. (2006). Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors. Journal of Acquired Immune Deficiency Syndromes, 41(3), 315–322. doi:10.1097/01.qai.0000197071.77482.6e.CrossRefPubMedGoogle Scholar
  34. Lorenz, K. A., Hays, R. D., Shapiro, M. F., Cleary, P. D., Asch, S. M., & Wenger, N. S. (2005). Religiousness and spirituality among HIV-infected Americans. Journal of Palliative Medicine, 8(4), 774–781. doi:10.1089/jpm.2005.8.774.CrossRefPubMedGoogle Scholar
  35. Lyimo, R. A., Stutterheim, S. E., Hospers, H. J., de Glee, T., van der Ven, A., & de Bruin, M. (2014). Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS, 28(2), 98–105.CrossRefPubMedGoogle Scholar
  36. Maman, S., Cathcart, R., Burkhardt, G., Omba, S., & Behets, F. (2009). The role of religion in HIV-positive women’s disclosure experiences and coping strategies in Kinshasa, Democratic Republic of Congo. Social Science and Medicine, 68(5), 965–970.CrossRefPubMedGoogle Scholar
  37. Mannheimer, S., Thackeray, L., Huppler Hullsiek, K., Chesney, M., Gardner, E. M., Wu, A. W., et al. (2008). A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care, 20(2), 161–169. doi:10.1080/09540120701534699.CrossRefPubMedGoogle Scholar
  38. Miles, M. S., Burchinal, P., Holditch-Davis, D., Wasilewski, Y., & Christian, B. (1997). Personal, family, and health-related correlates of depressive symptoms in mothers with HIV. Journal of Family Psychology, 11(1), 23.CrossRefGoogle Scholar
  39. Montaner, J. S., Reiss, P., Cooper, D., Vella, S., Harris, M., Conway, B., et al. (1998). A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients: The INCAS Trial. Italy, The Netherlands, Canada and Australia Study. JAMA, 279(12), 930–937.CrossRefPubMedGoogle Scholar
  40. Nguyen, V. K., Bajos, N., Dubois-Arber, F., O’Malley, J., & Pirkle, C. M. (2011). Remedicalizing an epidemic: From HIV treatment as prevention to HIV treatment is prevention. Aids, 25(3), 291–293. doi:10.1097/QAD.0b013e3283402c3e.CrossRefPubMedGoogle Scholar
  41. O’brien, R. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality & Quantity, 41(5), 673–690.CrossRefGoogle Scholar
  42. Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37(4), 710–724.CrossRefGoogle Scholar
  43. Parsons, S. K., Cruise, P. L., Davenport, W. M., & Jones, V. (2006). Religious beliefs, practices and treatment adherence among individuals with HIV in the Southern United States. AIDS Patient Care & STDs, 20(2), 97–111.CrossRefGoogle Scholar
  44. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133(1), 21–30.CrossRefPubMedGoogle Scholar
  45. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurements, 1, 385–401.CrossRefGoogle Scholar
  46. Radloff, L. S., & Locke, B. Z. (1986). The community mental health assessment survey and CES-D scale. In M. M. Weissman & J. K. Meyers (Eds.), Community surveys of psychiatric disorders (pp. 177–187). New Brunswick, NJ: Rutgers University Press.Google Scholar
  47. Roura, M., Nsigaye, R., Nhandi, B., Wamoyi, J., Busza, J., Urassa, M., et al. (2010). Driving the devil away”: Qualitative insights into miraculous cures for AIDS in a rural Tanzanian ward. BMC Public Health, 10(1), 427.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Safren, S. A., Otto, M. W., & Worth, J. L. (1999). Life-steps: Applying cognitive behavioral therapy to HIV medication adherence. Cognitive and Behavioral Practice, 6(4), 332–341. doi:10.1016/S1077-7229(99)80052-2.CrossRefGoogle Scholar
  49. Safren, S. A., Otto, M. W., Worth, J. L., Salomon, E., Johnson, W., Mayer, K., et al. (2001). Two strategies to increase adherence to HIV antiretroviral medication: Life-steps and medication monitoring. Behaviour Research and Therapy, 39(10), 1151–1162.CrossRefPubMedGoogle Scholar
  50. Sarason, I. G., Sarason, B. R., Shearin, E. N., & Pierce, G. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.CrossRefGoogle Scholar
  51. Sherr, L., Clucas, C., Harding, R., Sibley, E., & Catalan, J. (2011). HIV and depression–a systematic review of interventions. Psychol Health Med, 16(5), 493–527. doi:10.1080/13548506.2011.579990.CrossRefPubMedGoogle Scholar
  52. Stansell, J., Holtzer, C., Mayer, S., DeGuzman, D., Hamel, E., & Lapins, D. (2001). Factors affecting treatment outcomes in a medication event monitoring system. Paper presented at the Retroviruses and Opportunistic Infections, Chicago, Ill.Google Scholar
  53. Tarakeshwar, N., Khan, N., & Sikkema, K. J. (2006). A relationship-based framework of spirituality for individuals with HIV. AIDS and Behavior, 10(1), 59–70. doi:10.1007/s10461-005-9052-8.CrossRefPubMedGoogle Scholar
  54. Thielman, N. M., Ostermann, J., Whetten, K., Whetten, R., Itemba, D., Maro, V., et al. (2014). Reduced adherence to antiretroviral therapy among HIV-Infected Tanzanians seeking cure from the Loliondo Healer. JAIDS Journal of Acquired Immune Deficiency Syndromes, 65(3), e104–e109.CrossRefPubMedGoogle Scholar
  55. Tumwine, C., Neema, S., & Wagner, G. (2012). Reasons why high religiosity can co-exist with and precipitate discontinuation of anti-retroviral therapy among different HIV clients in Uganda: An exploratory study. Religions, 3(3), 817–832.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Vedhara, K., Schifitto, G., & McDermott, M. (1999). Disease progression in HIV-positive women with moderate to severe immunosuppression: The role of depression. Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Behavioral Medicine, 25(1), 43–47. doi:10.1080/08964289909596738.CrossRefPubMedGoogle Scholar
  57. Vyas, K. J., Limneos, J., Qin, H., & Mathews, W. C. (2014). Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons. AIDS Care, 26(8), 983–987.CrossRefPubMedGoogle Scholar
  58. Wanyama, J., Castelnuovo, B., Wandera, B., Mwebaze, P., Kambugu, A., Bangsberg, D. R., et al. (2007). Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. Aids, 21(11), 1486–1487.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Safiya George Dalmida
    • 1
  • Katryna McCoy
    • 2
  • Harold G. Koenig
    • 3
    • 4
  • Aretha Miller
    • 5
  • Marcia McDonnell Holstad
    • 6
  • Tami Thomas
    • 7
  • Dora Clayton-Jones
    • 8
  • Mary Grant
    • 9
  • Terri Fleming
    • 6
  • Menka Munira Wirani
    • 6
  • George Mugoya
    • 10
  1. 1.Capstone College of NursingThe University of AlabamaTuscaloosaUSA
  2. 2.School of Nursing and Health StudiesUniversity of WashingtonBothellUSA
  3. 3.Department of PsychiatryDuke University Medical CenterDurhamUSA
  4. 4.Department of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
  5. 5.College of Health SciencesWalden UniversityMinneapolisUSA
  6. 6.Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaUSA
  7. 7.Nicole Werthiem College of Nursing and Health SciencesFlorida International UniversityMiamiUSA
  8. 8.College of NursingUniversity of Wisconsin-MilwaukeeMilwaukeeUSA
  9. 9.Duke UniversityDurhamUSA
  10. 10.College of EducationThe University of AlabamaTuscaloosaUSA

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