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The Longitudinal Association between Social Support on HIV Medication Adherence and Healthcare Utilization in the Women’s Interagency HIV Study

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Abstract

Social support is associated with HIV-related health outcomes. However, few studies have explored this longitudinally. We assessed psychometric properties of the Medical Outcomes Study’s Social Support Survey among women in the Women’s Interagency HIV Study, and explored the longitudinal effects of social support on HIV medication adherence (HIV-positive women) and healthcare utilization (HIV-positive and negative women). The 15 questions loaded into two factors, with Cronbach’s Alpha > 0.95. Over 3 years, perceived emotional support was associated with optimal medication adherence (OR 1.19, 95% CI 1.10–1.28) and healthcare utilization (OR 1.16, 95% CI 1.05–1.27), and tangible social support with adherence only (OR 1.18, 95% CI 1.08–1.27) when controlling for covariates, including core sociodemographic characteristics and depressive symptoms. Interventions to further understand the drivers of sub-types of social support as well as enhance sustained social support may assist with optimizing care of women with and at risk for HIV.

Resumen

El apoyo social está asociado con los resultados de salud relacionados con el VIH. Sin embargo, pocos estudios han explorado esto longitudinalmente. Evaluamos las propiedades psicométricas de la Encuesta de Apoyo Social del Estudio de Resultados Médicos entre las mujeres en el Estudio Interinstitucional del VIH de Mujeres, y exploramos los efectos longitudinales del apoyo social sobre la adherencia a los medicamentos contra el VIH (mujeres VIH positivas) y la utilización de la atención médica (mujeres VIH positivas y negativas). Las 15 preguntas se cargaron en dos factores, con el Alfa de Cronbach > 0.95. Durante tres años, el apoyo emocional percibido se asoció con una adherencia óptima a la medicación (Proporcion de probabilidades (OR) 1.19, Intervalo de confianza (CI) 95%: 1.10–1.28) y la utilización de la atención médica (OR 1.16, CI 95%: 1.05–1.27) y apoyo social tangible con adherencia solamente (OR 1,18, CI del 95%: 1,08–1,27) al controlar las covariables, incluidas las características sociodemográficas principales y los síntomas depresivos. Las intervenciones para comprender mejor los impulsores de los subtipos de apoyo social, así como para mejorar el apoyo social sostenido, pueden ayudar a optimizar la atención de las mujeres con y en riesgo de contraer el VIH.

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Acknowledgements

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I–WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), and P30-AI-050410 (UNC CFAR).

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Aruna Chandran, Lorie Benning & Elizabeth T. Golub

  2. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Rashelle J. Musci

  3. Department of Community Health Sciences, SUNY Downstate Medical Center, School of Public Health, Brooklyn, NY, USA

    Tracey E. Wilson

  4. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    Joel Milam

  5. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola Adedimeji

  6. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Carrigan Parish

  7. Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA

    Adaora A. Adimora

  8. Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA

    Jennifer Cocohoba

  9. Cook County Health and Hospital System, Chicago, IL, USA

    Mardge H. Cohen

  10. Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA

    Marcia Holstad

  11. Department of Medicine/Infectious Diseases, Georgetown University, Washington, DC, USA

    Seble Kassaye

  12. Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Mirjam-Colette Kempf

  13. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W6501, Baltimore, MD, 21205, USA

    Aruna Chandran

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  1. Aruna Chandran
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Correspondence to Aruna Chandran.

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None of the authors have any conflicts of interest to report.

Ethical Approval

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. The WIHS protocol was approved by the Institutional Review Board at each study site’s institution and by the WIHS executive committee.

Informed Consent

Informed consent was obtained from all individual participants included in the study. Individuals were compensated for their participation in the study.

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Chandran, A., Benning, L., Musci, R.J. et al. The Longitudinal Association between Social Support on HIV Medication Adherence and Healthcare Utilization in the Women’s Interagency HIV Study. AIDS Behav 23, 2014–2024 (2019). https://doi.org/10.1007/s10461-018-2308-x

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