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Psychological Reactance is a Novel Risk Factor for Adolescent Antiretroviral Treatment Failure


Psychological reactance is an aversive response to perceived threats against personal agency. For adolescents receiving HIV treatment in Botswana, we utilized a two-question, medication-specific reactance tool to assess whether: (1) verbal reminders to take medicines made adolescents want to avoid taking them, and, (2) whether adolescents felt anger when reminded to take medicines. Reactant adolescents had 2.05-fold (95% CI 1.23, 3.41) greater odds of treatment failure than non-reactant adolescents (p = 0.03). Adjusted risk of treatment failure was 14% (95% CI 3%, 28%) greater for each point elevation in reactance score (p = 0.016). Autonomy over medication-taking did not modify the association between reactance and treatment failure. Psychological reactance may be a useful interventional target for improving adolescent adherence.

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The study team would like to thank the adolescents and staff at the Botswana-Baylor Children’s Clinical Centre of Excellence for their support of this work. The project was made possible through core services and support from the Penn Center for AIDS Research (CFAR), an NIH-funded program (P30 AI 045008) the Penn Mental Health AIDS Research Center (P30 MH097488), D43 TW009781, and the Carole Marcus Mid-Career Award to Promote Career Development and Mentoring in Pediatric Research. This work was also supported by NIH K23 MH095669. The funders did not play a role in study design, analysis, or the decision to publish this research.

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Correspondence to Elizabeth Lowenthal.

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Lowenthal, E., Matesva, M., Marukutira, T. et al. Psychological Reactance is a Novel Risk Factor for Adolescent Antiretroviral Treatment Failure. AIDS Behav 25, 1474–1479 (2021).

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  • HIV
  • Adherence
  • Adolescent behavior
  • Antiretroviral therapy
  • Africa
  • Psychological reactance