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HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS

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Abstract

HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.

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References

  • Anema, A., Vogenthaler, N., Frongillo, E. A., Kadiyala, S., & Weiser, S. D. (2009). Food insecurity and HIV/AIDS: Current knowledge, gaps, and research priorities. Current HIV/AIDS Reports, 6(4), 224–231.

    Article  PubMed  Google Scholar 

  • Bangsberg, D. R., & Deeks, S. G. (2002). Is average adherence to HIV antiretroviral therapy enough? Journal of General Internal Medicine, 17(10), 812–813.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bottonari, K. A., Roberts, J. E., Ciesla, J. A., & Hewitt, R. G. (2005). Life stress and adherence to antiretroviral therapy among HIV-positive individuals: A preliminary investigation. AIDS Patient Care and STDs, 19(11), 719–727.

    Article  PubMed  Google Scholar 

  • Bottonari, K. A., Safren, S. A., McQuaid, J. R., Hsiao, C. B., & Roberts, J. E. (2010). A longitudinal investigation of the impact of life stress on HIV treatment adherence. Journal of Behavioral Medicine, 33(6), 486–495.

    Article  PubMed  PubMed Central  Google Scholar 

  • Braithwaite, R. S., McGinnis, K., Conigliaro, J., Maisto, S. A., Crystal, S., Day, N., … Justice, A. (2005). A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcoholism, Clinical and Experimental Research, 29, 190–197.

  • Carrieri, M. P., Villes, V., Raffi, F., Protopopescu, C., Preau, M., Salmon, D., … APROCO-COPILOTE COHORT ANRS CO-8 Study Group. (2007). Self-reported side-effects of anti-retroviral treatment among IDUs: A 7-year longitudinal study (APROCO-COPILOTE COHORT ANRS CO-8). International Journal of Drug Policy, 18(4), 288–295.

    Article  PubMed  Google Scholar 

  • Chesney, M., Folkman, S., & Chambers, D. (1996). Coping effectiveness training for men living with HIV: Preliminary findings. International Journal of STD and AIDS, 7(Suppl 2), 75–82.

    Article  PubMed  Google Scholar 

  • Dejesus, E., Young, B., Morales-Ramirez, J. O., Sloan, L., Ward, D. J., Flaherty, J. F., & Farajallah, A. (2009). Simplification of antiretroviral therapy to a single-tablet regimen consisting of efavirenz, emtricitabine, and tenofovir disoproxil fumarate versus unmodified antiretroviral therapy in virologically suppressed HIV-1-infected patients. Journal of Acquired Immune Deficiency Syndromes, 51(2), 163–174.

    Article  CAS  PubMed  Google Scholar 

  • DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207–218.

    Article  PubMed  Google Scholar 

  • Evans, G. W., Gonnella, C., Marcynyszyn, L. A., Gentile, L., & Salpekar, N. (2005). The role of chaos in poverty and children’s socioemotional adjustment. Psychological Sciences, 16(7), 560–565.

    Article  Google Scholar 

  • Faramawi, M. F., Johnson, E., Fry, M. W., Sall, M., & Zhou, Y. (2007). Consumption of different types of meat and the risk of renal cancer: Meta-analysis of case-control studies. Cancer Causes and Control, 18(2), 125–133.

    Article  PubMed  Google Scholar 

  • Georgia Department of Public Health. (2013). HIV/AIDS Surveillance Report. Retrieved June 20, 2016, from https://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section.

  • Groleau, V., Herold, R. A., Schall, J. I., Wagner, J. L., Dougherty, K. A., Zemel, B. S., & Stallings, V. A. (2013). Blood lead concentration is not altered by high-dose vitamin D supplementation in children and young adults with HIV. Journal of Pediatric Gastroenterology and Nutrition 56(3), 316–319.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Haberer, J. E., Robbins, G. K., Ybarra, M., Monk, A., Ragland, K., Weiser, S. D., … Bangsberg, D. R. (2011). Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable. AIDS and Behavior, 16(2), 375–382.

  • Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. Retrieved from http://www.afhayes.com/public/process2012.pdf.

  • Ivers, L. C., Cullen, K. A., Freedberg, K. A., Block, S., Coates, J., & Webb, P. (2009). HIV/AIDS, undernutrition, and food insecurity. Clinical Infectious Diseases, 49(7), 1096–1102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, M. O., & Neilands, T. B. (2007). Coping with HIV treatment side effects: Conceptualization, measurement, and linkages. AIDS and Behavior, 11(4), 575–585.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalichman, S. C., Amaral, C. M., Cherry, C., Flanagan, J. A., Pope, H., Eaton, L., … Schinazi, R. (2008). Monitoring Antiretroviral adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials, 9, 298–308.

  • Kalichman, S. C., Amaral, C., Swetsze, C., Eaton, L., Kalichman, M. O., Cherry, C., … Schinazi, R. F. (2010). Monthly unannounced pill counts for monitoring HIV treatment adherence: Tests for self-monitoring and reactivity effects. HIV Clinical Trials, 11(6), 325–331.

  • Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., & DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26(4), 315–332.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., Hernandez, D., Cherry, C., Kalichman, M. O., Washington, C., & Grebler, T. (2014). Food insecurity and other poverty indicators among people living with HIV/AIDS: Effects on treatment and health outcomes. Journal of Community Health, 39(6), 1133–1139.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalichman, S. C., Rompa, D., & Cage, M. (2000). Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. Journal of Nervous and Mental Disorders, 188(10), 662–670.

    Article  CAS  Google Scholar 

  • Kalichman, S. C., Washington, C., Grebler, T., Hoyt, G., Welles, B., Kegler, C., … Cherry, C. (2015). Medication adherence and health outcomes of people living with HIV who are food insecure and prescribed antiretrovirals that should be taken with food. Infectious Disease Therapy. doi:10.1007/s40121-015-0057-y.

  • Kalichman, S. C., Washington, C., Grebler, T., Hoyt, G., Welles, B., Merely, C., … Cherry, C. (2015). Treatment outcomes among people living with HIV who are food insecure and prescribed antiretrovirals taken with food. Journal of Primary Care and Community Health, 6(1), 35–40.

  • Leaver, C. A., Bargh, G., Dunn, J. R., & Hwang, S. W. (2007). The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. AIDS and Behavior, 11(6 Suppl), 85–100.

    Article  PubMed  Google Scholar 

  • Leserman, J., Ironson, G., O’Cleirigh, C., Fordiani, J. M., & Balbin, E. (2008). Stressful life events and adherence in HIV. AIDS Patient Care and STDs, 22(5), 403–411.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lima, V. D., Bangsberg, D. R., Harrigan, P. R., Deeks, S. G., Yip, B., Hogg, R. S., & Montaner, J. S. (2010). Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level. Journal of Acquired Immune Deficiency Syndromes, 55(4), 460–465.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., & Kelley, M. E. (2000). An empirical investigation of the factor structure of the AUDIT. Psychological Assessment, 12(3), 346–353.

    Article  CAS  PubMed  Google Scholar 

  • Matheny, A., Wachs, T., Ludwig, J., & Phillips, K. (1995). Bringing order out of chaos: Psychometric characteristics of the confusion, Hubbub, and Order Scale. Journal of Applied Developmental Psychology, 16, 429–444.

    Article  Google Scholar 

  • McManus, H., O’Connor, C. C., Boyd, M., Broom, J., Russell, D., Watson, K., … Australian, H. I. V. O. D. (2012). Long-term survival in HIV positive patients with up to 15 years of antiretroviral therapy. PLoS ONE, 7(11), e48839.

  • Morrison-Beedy, D., Carey, M. P., & Tu, X. (2006). Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior. AIDS and Behavior, 10(5), 541–552.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mugavero, M. J., Raper, J. L., Reif, S., Whetten, K., Leserman, J., Thielman, N. M., & Pence, B. W. (2009). Overload: Impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study. Psychosomatic Medicine, 71(9), 920–926.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ortego, C., Huedo-Medina, T. B., Llorca, J., Sevilla, L., Santos, P., Rodriguez, E., … Vejo, J. (2011). Adherence to highly active antiretroviral therapy (HAART): A meta-analysis. AIDS and Behavior, 15(7), 1381–1396.

  • Parienti, J. J., Bangsberg, D. R., Verdon, R., & Gardner, E. M. (2009). Better adherence with once-daily antiretroviral regimens: A meta-analysis. Clinical Infectious Diseases, 48(4), 484–488.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parienti, J. J., Barrail-Tran, A., Duval, X., Nembot, G., Descamps, D., Vigan, M., … Goujard, C. (2013). Adherence profiles and therapeutic responses of treatment-naive HIV-infected patients starting boosted atazanavir-based therapy in the ANRS 134-COPHAR 3 trial. Antimicrobial Agents and Chemotherapy, 57(5), 2265–2271.

  • Pellowski, J. A., Kalichman, S. C., Matthews, K. A., & Adler, N. (2013). A pandemic of the poor: Social disadvantage and the U.S. HIV epidemic. American Psychologist, 68(4), 197–209.

    Article  PubMed  PubMed Central  Google Scholar 

  • Petersen, M. L., Wang, Y., van der Laan, M. J., Guzman, D., Riley, E., & Bangsberg, D. R. (2007). Pillbox organizers are associated with improved adherence to HIV antiretroviral therapy and viral suppression: A marginal structural model analysis. Clinical Infectious Diseases, 45(7), 908–915.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Preacher, K. J., Rucker, D., & Hayes, A. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42, 185–227.

    Article  PubMed  Google Scholar 

  • Scott-Sheldon, L. A., Kalichman, S. C., Carey, M. P., & Fielder, R. L. (2008). Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006. Health Psychology, 27(2), 129–139.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smolderen, K. G., & Whooley, M. A. (2013). Psychological distress and medication adherence: Creating order out of chaos? Circulation and Cardiovascular Quality Outcomes, 6(6), 615–616.

    Article  Google Scholar 

  • Surratt, H. L., O’Grady, C. L., Levi-Minzi, M. A., & Kurtz, S. P. (2015). Medication adherence challenges among HIV positive substance abusers: The role of food and housing insecurity. AIDS Care, 27(3), 307–314.

    Article  PubMed  Google Scholar 

  • Tuller, D. M., Bangsberg, D. R., Senkungu, J., Ware, N. C., Emenyonu, N., & Weiser, S. D. (2009). Transportation costs impede sustained adherence and access to HAART in a clinic population in Southwestern Uganda: A qualitative study. AIDS and Behavior, 14(4), 778–784.

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Dam, N. T., & Earleywine, M. (2011). Validation of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186(1), 128–132.

    Article  PubMed  Google Scholar 

  • van der Sande, M. A., Schim van der Loeff, M. F., Aveika, A. A., Sabally, S., Togun, T., Sarge-Njie, R., & Whittle, H. C. (2004). Body mass index at time of HIV diagnosis: A strong and independent predictor of survival. Journal of Acquired Immune Deficiency Syndromes, 37(2), 1288–1294.

    Article  PubMed  Google Scholar 

  • Wagner, G. J., & Ryan, G. W. (2004). Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users. AIDS Patient Care and STDs, 18(7), 385–393.

    Article  PubMed  Google Scholar 

  • Weiser, S. D., Hatcher, A., Frongillo, E. A., Guzman, D., Riley, E. D., Bangsberg, D. R., & Kushel, M. B. (2012). Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco. Journal of General Internal Medicine, 28(1), 91–98.

    Article  PubMed  PubMed Central  Google Scholar 

  • Welty, T. E., Willis, S. L., & Welty, E. A. (2010). Effect of limited transportation on medication adherence in patients with epilepsy. Journal of the American Pharmacists Association, 50(6), 698–703.

    Article  PubMed  Google Scholar 

  • Wong, M. D., Sarkisian, C. A., Davis, C., Kinsler, J., & Cunningham, W. E. (2007). The association between life chaos, health care use, and health status among HIV-infected persons. Journal of General Internal Medicine, 22(9), 1286–1291.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zullig, L. L., Shaw, R. J., Crowley, M. J., Lindquist, J., Grambow, S. C., Peterson, E., & Bosworth, H. B. (2013). Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circulation and Cardiovascular Quality Outcomes, 6(6), 619–625.

    Article  Google Scholar 

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Acknowledgements

Seth Kalichman has received research grants from the National Institutes of Health. This research was funded by National Institute of Nursing Research Grant 418 R01-NR012962, National Institute of Alcohol Abuse and Alcoholism Grant R01-419 AA021471 and the National Institute on Drug Abuse Grant R01-DA033067.

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  1. Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA

    Seth C. Kalichman & Moira O. Kalichman

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  1. Seth C. Kalichman
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  2. Moira O. Kalichman
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Correspondence to Seth C. Kalichman.

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Seth C. Kalichman and Moira O. Kalichman declare they have no other conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Kalichman, S.C., Kalichman, M.O. HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS. J Clin Psychol Med Settings 23, 420–430 (2016). https://doi.org/10.1007/s10880-016-9481-8

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