Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway

  • Jacklyn D. Babowitch
  • Alan Z. Sheinfil
  • Sarah E. Woolf-King
  • Peter A. Vanable
  • Shannon M. Sweeney
Original Paper

Abstract

Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.

Keywords

HIV Depressive symptoms Antiretroviral therapy (ART) Adherence 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

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

References

  1. 1.
    CDC. Diagnoses of HIV Infection in the United States and Dependent Areas, 2014. HIV Surveillance Report 2015. 2016;26.Google Scholar
  2. 2.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.CrossRefPubMedGoogle Scholar
  4. 4.
    Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301(22):2380–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Dodd PJ, Garnett GP, Hallett TB. Examining the promise of HIV elimination by ‘test and treat’ in hyperendemic settings. AIDS (London, England). 2010;24(5):729–35.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet (London, England). 2009;373(9657):48–57.CrossRefGoogle Scholar
  7. 7.
    Kalichman SC, Cherry C, Amaral CM, et al. Adherence to antiretroviral therapy and HIV transmission risks: implications for test-and-treat approaches to HIV prevention. AIDS Patient Care STDs. 2010;24(5):271–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ickovics JR, Cameron A, Zackin R, et al. Consequences and determinants of adherence to antiretroviral medication: results from Adult AIDS Clinical Trials Group protocol 370. Antivir Ther. 2002;7(3):185–93.PubMedGoogle Scholar
  9. 9.
    Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis. 2002;34(8):1115–21.CrossRefPubMedGoogle Scholar
  10. 10.
    McNabb J, Ross JW, Abriola K, Turley C, Nightingale CH, Nicolau DP. Adherence to highly active antiretroviral therapy predicts virologic outcome at an inner-city human immunodeficiency virus clinic. Clin Infect Dis. 2001;33(5):700–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr (1999). 2011;58(2):181–7.CrossRefGoogle Scholar
  13. 13.
    Markowitz JC, Rabkin JG, Perry SW. Treating depression in HIV-positive patients. AIDS (London, England). 1994;8(4):403–12.CrossRefGoogle Scholar
  14. 14.
    Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Onken LS, Carroll KM, Shoham V, Cuthbert BN, Riddle M. Reenvisioning clinical science: unifying the discipline to improve the public health. Clin Psychol Sci. 2014;2(1):22–34.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kennedy SH. Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues Clin Neurosci. 2008;10(3):271–7.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall, Inc; 1986.Google Scholar
  19. 19.
    Houston E, Mikrut C, Guy A, et al. Another look at depressive symptoms and antiretroviral therapy adherence: the role of treatment self-efficacy. J Health Psychol. 2016;21(10):2138–47.CrossRefPubMedGoogle Scholar
  20. 20.
    Nokes K, Johnson MO, Webel A, et al. Focus on increasing treatment self-efficacy to improve human immunodeficiency virus treatment adherence. J Nurs Scholarsh. 2012;44(4):403–10.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tyer-Viola LA, Corless IB, Webel A, Reid P, Sullivan KM, Nichols P. Predictors of medication adherence among HIV women in North America. J Obstet Gynecol Neonatal Nurs. 2014;43(2):168–78.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cha E, Erlen JA, Kim KH, Sereika SM, Caruthers D. Mediating roles of medication-taking self-efficacy and depressive symptoms on self-reported medication adherence in persons with HIV: a questionnaire survey. Int J Nurs Stud. 2008;45(8):1175–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Archiopoli A, Ginossar T, Wilcox B, Avila M, Hill R, Oetzel J. Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence. AIDS Care. 2016;28(12):1607–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Tatum AK, Houston E. Examining the interplay between depression, motivation, and antiretroviral therapy adherence: a social cognitive approach. AIDS Care. 2017;29(3):306–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Kekwaletswe CT, Jordaan E, Nkosi S, Morojele NK. 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. 2017;21(7):1846–56.CrossRefPubMedGoogle Scholar
  26. 26.
    Lehane E, McCarthy G. Intentional and unintentional medication non-adherence: a comprehensive framework for clinical research and practice? A discussion paper. Int J Nurs Stud. 2007;44(8):1468–77.CrossRefPubMedGoogle Scholar
  27. 27.
    Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2002;25(4):355–72.CrossRefPubMedGoogle Scholar
  28. 28.
    Mo PK, Mak WW. Intentionality of medication non-adherence among individuals living with HIV/AIDS in Hong Kong. AIDS Care. 2009;21(6):785–95.CrossRefPubMedGoogle Scholar
  29. 29.
    Levy RW, Rayner CR, Fairley CK, et al. Multidisciplinary HIV adherence intervention: a randomized study. AIDS Patient Care STDS. 2004;18(12):728–35.CrossRefPubMedGoogle Scholar
  30. 30.
    Sweeney SM. Understanding mediators of the relationship between HIV-related stigma and medication adherence among people living with HIV. Dissertations - ALL. 2016;665.Google Scholar
  31. 31.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction. 1993;88(6):791–804.CrossRefPubMedGoogle Scholar
  32. 32.
    Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  33. 33.
    Reisner SL, Mimiaga MJ, Skeer M, et al. Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav. 2009;13(4):798–810.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV treatment adherence self-efficacy scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Kalichman SC, Rompa D, Cage M. Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. Int J STD AIDS. 2000;11(9):579–85.CrossRefPubMedGoogle Scholar
  38. 38.
    Sewell J, Daskalopoulou M, Nakagawa F, et al. Accuracy of self-report of HIV viral load among people with HIV on antiretroviral treatment. HIV Med. 2016.Google Scholar
  39. 39.
    Voss JG, Cesan A, Jensen K, et al. Agreement between self-reported knowledge and medical record data. Clin Nurs Res. 2015;24(3):318–36.CrossRefPubMedGoogle Scholar
  40. 40.
    Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Allyn & Bacon/Pearson Education; 2007.Google Scholar
  41. 41.
    Kim HY. Statistical notes for clinical researchers: evaluation of measurement error 1: using intraclass correlation coefficients. Restor Dent Endod. 2013;38(2):98–102.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.CrossRefPubMedGoogle Scholar
  43. 43.
    Beer L, Skarbinski J. Adherence to antiretroviral therapy among HIV-infected adults in the United States. AIDS Educ Prev. 2014;26(6):521–37.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Sullivan LE, Saitz R, Cheng DM, Libman H, Nunes D, Samet JH. The impact of alcohol use on depressive symptoms in human immunodeficiency virus-infected patients. Addiction (Abingdon, England). 2008;103(9):1461–7.CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: Review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.Google Scholar
  47. 47.
    Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.CrossRefPubMedGoogle Scholar
  48. 48.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82.CrossRefPubMedGoogle Scholar
  49. 49.
    Uthman OA, Magidson JF, Safren SA, Nachega JB. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep. 2014;11(3):291–307.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Arnsten JH, Demas PA, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001;33(8):1417–23.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Wagner G, Miller LG. Is the influence of social desirability on patients’ self-reported adherence overrated? J Acquir Immune Defic Syndr. (1999). 2004;35(2):203–4.CrossRefGoogle Scholar
  52. 52.
    Gandhi M, Ameli N, Bacchetti P, et al. Atazanavir concentration in hair is the strongest predictor of outcomes on antiretroviral therapy. Clin Infect Dis. 2011;52(10):1267–75.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Hickey MD, Salmen CR, Tessler RA, et al. Antiretroviral concentrations in small hair samples as a feasible marker of adherence in rural Kenya. J Acquir Immune Defic Syndr. (1999). 2014;66(3):311–5.CrossRefGoogle Scholar
  54. 54.
    Milam J, Richardson JL, McCutchan A, et al. Effect of a brief antiretroviral adherence intervention delivered by HIV care providers. J Acquir Immune Defic Syndr. 2005;40(3):356–63.CrossRefPubMedGoogle Scholar
  55. 55.
    Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA. The NHLPT. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: The Healthy Living Project randomized controlled study. J Acquir Immune Defic Syndr. (1999). 2007;46(5):574–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jacklyn D. Babowitch
    • 1
  • Alan Z. Sheinfil
    • 1
  • Sarah E. Woolf-King
    • 1
  • Peter A. Vanable
    • 1
  • Shannon M. Sweeney
    • 1
  1. 1.Department of PsychologySyracuse UniversitySyracuseUSA

Personalised recommendations