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Non-planning Impulsivity But Not Behavioral Impulsivity is Associated with HIV Medication Non-adherence

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Abstract

Despite advances in HIV antiretroviral medications, some patients do not achieve adequate medication adherence or suppressed viral load. The aim of this study was to identify the relationship between factors of impulsivity and medication non-adherence. It was hypothesized that impulsivity would have a direct association with non-adherence, after accounting for other known correlates. Participants included 322 HIV positive individuals (M age = 49, 56% male, 64% Black/African American). Impulsivity was measured using the Barratt Impulsiveness Scale-Brief (BIS-Brief). Factor analysis was conducted to determine if BIS-Brief resulted in a unidimensional or multi-factor solution. Results were suggestive of a two-factor solution: behavioral impulsivity and non-planning impulsivity. Structural equation modeling found non-planning impulsivity was associated with non-adherence (β = 0.18, p = 0.016), while no significant association was observed for behavioral impulsiveness. Results suggest that strategies related to planning for future consequences may be beneficial for impulsive persons with medication adherence difficulties.

Resumen

A pesar de los avances en los medicamentos antirretrovirales contra el VIH, algunos no logran una adherencia adecuada a los medicamentos ni suprimen la carga viral. El objetivo de este estudio fue identificar la relación entre los factores de impulsividad y la adherencia a la medicación. Se formuló la hipótesis de que la impulsividad tendría una asociación directa con la falta de adherencia, después de tener en cuenta otros correlativos conocidos. Los participantes incluyeron 322 individuos VIH positivos (M edad = 49, 56% hombres, 64% Black/African American). La impulsividad se midió usando la Barratt Impulsiveness Scale-Brief (BIS-Brief). El análisis factorial se realizó para determinar si BIS-Brief dio como resultado una solución unidimensional o multifactorial. Los resultados sugirieron una solución de dos factores: impulsividad conductual e impulsividad no planificada. El modelado de ecuaciones estructurales encontró que la impulsividad no planificada se asoció negativamente con la adherencia (β = 0.18, p = 0.02), mientras que no se observó una asociación significativa para la impulsividad conductual. Los resultados sugieren que las estrategias relacionadas con la planificación de las consecuencias futuras pueden ser beneficiosas para las personas impulsivas con dificultades de adherencia.

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Funding

This research was supported by the Southern HIV and Alcohol Research Consortium (SHARC; U24AA022002; PI: Cook). Eugene M. Dunne, PhD received predoctoral support through the NIDA-funded University of Florida Substance Abuse Training Center in Public Health (T32DA035167; PI: Linda B. Cottler, PhD, MPH, FACE) and postdoctoral support through the NIMH-funded Adolescent/Young Adult Biobehavioral HIV Training Grant (T32MH078788; PI: Larry K. Brown, MD). Nicole Ennis, PhD received support from the National Institute of Drug Abuse under Grant #K23DA039769-01 (PI: Ennis). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the Florida Department of Health HIV Surveillance Section for helping to provide viral load data to the Florida Cohort project.

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Correspondence to Eugene M. Dunne.

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

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

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Dunne, E.M., Cook, R.L. & Ennis, N. Non-planning Impulsivity But Not Behavioral Impulsivity is Associated with HIV Medication Non-adherence. AIDS Behav 23, 1297–1305 (2019). https://doi.org/10.1007/s10461-018-2278-z

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