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Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa

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Abstract

We sought to (a) replicate and (b) extend (via the addition of alcohol use) Cha et al.’s cross-sectional multi-component model of ART adherence on the relationship between social support, depression, self-efficacy beliefs, and antiretroviral therapy (ART) adherence, among HIV patients in Tshwane, South Africa. Using purposive sampling, 304 male and female ART recipients were recruited. ART adherence was assessed using three manifest indicators: total adherence ratio, the CASE adherence index and 1-month adherence measure. Data were analysed using structural equation modeling. In our replicated model, social support had both direct and indirect relationships with ART adherence, and inclusion of alcohol use improved prediction of ART adherence. Direct and indirect effects of alcohol use on ART adherence emerged: adherence self-efficacy beliefs partially mediated the latter path. Findings highlight the importance of integrating into ART promotion interventions, the reduction of alcohol use, provision of social support, and enhancement of adherence self-efficacy beliefs.

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Acknowledgments

The authors would like to thank Dr Hermann Swart for his statistical input, Ms Mantoa Nzeku for managing the study and Ms Naledi Kitleli and Mr Kgalabi Ngako for supervising the field staff. We are thankful to the clinic sites’ managers and health care providers and the patients for consenting to participate in this study.

Funding

This article was supported by Cooperative Agreement Number U2G/PS001137-02 from Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

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Authors and Affiliations

  1. Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Private Bag X385, Pretoria, South Africa

    Connie T. Kekwaletswe, Sebenzile Nkosi & Neo K. Morojele

  2. Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa

    Esmé Jordaan

  3. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

    Neo K. Morojele

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  1. Connie T. Kekwaletswe
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  2. Esmé Jordaan
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  3. Sebenzile Nkosi
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Correspondence to Connie T. Kekwaletswe.

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Dr. Connie Kekwaletswe, Ms. Esmé Jordaan, Ms. Sebenzile Nkosi, and Prof. Neo K. Morojele declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were 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. This article does not contain any studies with animals performed by any of the authors.

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

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Kekwaletswe, C.T., Jordaan, E., Nkosi, S. et al. Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa. AIDS Behav 21, 1846–1856 (2017). https://doi.org/10.1007/s10461-016-1595-3

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