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AIDS and Behavior

, Volume 23, Issue 5, pp 1297–1305 | Cite as

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

  • Eugene M. DunneEmail author
  • Robert L. Cook
  • Nicole Ennis
Original Paper

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.

Keywords

HIV Medication adherence Antiretroviral therapy Impulsivity 

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.

Notes

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.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethnical 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.
    Centers for Disease Control and Prevention. HIV incidence: estimated annual infections in the U.S., 2008–2014. CDC Fact Sheets. 2015.Google Scholar
  2. 2.
    Ray M, Logan R, Sterne J, et al. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010;24(1):123.CrossRefGoogle Scholar
  3. 3.
    Kyser M, Buchacz K, Bush TJ, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011;23:601–11.CrossRefGoogle Scholar
  4. 4.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Cook R, Zhou Z, Kelso-Chichetto N, et al. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract. 2017;12:22.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Beer L, Heffelfinger J, Frazier E, et al. Use of and adherence to antiretroviral therapy in a large US sample of HIV-infected adults in care, 2007-2008. Open AIDS J. 2012;6:213.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV Surveillance Supplemental Report, vol. 172012.Google Scholar
  8. 8.
    Chesney MA, Morin M, Sherr L. Adherence to HIV combination therapy. Soc Sci Med. 2000;50:1599–605.CrossRefGoogle Scholar
  9. 9.
    Tucker JS, Burnam MA, Sherbourne CD, Kung F-Y, Gifford AL. Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003;114(7):573–80.CrossRefGoogle Scholar
  10. 10.
    Nel A, Kagee A. The relationship between depression, anxiety and medication adherence among patients receiving antiretroviral treatment in South Africa. AIDS Care. 2013;25:948–55.CrossRefGoogle Scholar
  11. 11.
    Nicholas PK, Willard S, Thompson C, et al. Engagement with care, substance use, and adherence to therapy in HIV/AIDS. AIDS Res Treat. 2014;2014:7.Google Scholar
  12. 12.
    Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158:1783–93.CrossRefGoogle Scholar
  13. 13.
    Swann AC, Janicak PL, Calabrese JR, et al. Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants. J Affect Disord. 2001;67:123–32.CrossRefGoogle Scholar
  14. 14.
    Robbins TW, Gillan CM, Smith DG, de Wit S, Ersche KD. Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends Cogn Sci. 2012;16:81–91.CrossRefGoogle Scholar
  15. 15.
    Acton GS. Measurement of impulsivity in a hierarchical model of personality traits: implications for substance use. Subst Use Misuse. 2003;38:67–83.CrossRefGoogle Scholar
  16. 16.
    Oshri A, Tubman JG, Morgan-Lopez AA, Saavedra LM, Csizmadia A. Sexual sensation seeking, co-occurring sex and alcohol use, and sexual risk behavior among adolescents in treatment for substance use problems. Am J Addict. 2013;22:197–205.CrossRefGoogle Scholar
  17. 17.
    Barratt ES. Impulsiveness subtraits: arousal and information processing. In: Spence JT, Itard CE, editors. Motivation, emotion, and personality. Amsterdam: Elsevier; 1985. p. 137–46.Google Scholar
  18. 18.
    Patton JH, Stanford MS. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51:768–74.CrossRefGoogle Scholar
  19. 19.
    Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: an update and review. Pers Individ Differ. 2009;47:385–95.CrossRefGoogle Scholar
  20. 20.
    Belzeaux R, Boyer L, Mazzola-Pomietto P, et al. Adherence to medication is associated with non-planning impulsivity in euthymic bipolar disorder patients. J Affect Disord. 2015;184:60–6.CrossRefGoogle Scholar
  21. 21.
    Steinberg L, Sharp C, Stanford MS, Tharp AT. New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief). Psychol Assess. 2013;25:216.CrossRefGoogle Scholar
  22. 22.
    Wilson IB, Lee Y, Michaud J, Fowler FJ, Rogers WH. Validation of a new three-item self-report measure for medication adherence. AIDS Behav. 2016;20:2700–8.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med. 2015;5:470–82.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.CrossRefGoogle Scholar
  26. 26.
    Arbuckle JL. Amos 23.0 user’s guide. Chicago: IBM SPSS; 2014.Google Scholar
  27. 27.
    DeVillis RF. Scale development: theory and application. 2nd ed. Thousand Oaks, CA: Sage; 2003.Google Scholar
  28. 28.
    Hayes-Roth B, Hayes-Roth F. A cognitive model of planning. Cogn Sci. 1979;3:275–310.CrossRefGoogle Scholar
  29. 29.
    Marazziti D, Consoli G, Picchetti M, Carlini M, Faravelli L. Cognitive impairment in major depression. Eur J Pharmacol. 2010;626:83–6.CrossRefGoogle Scholar
  30. 30.
    Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97:2238–45.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Saddichha S, Schuetz C. Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Compr Psychiatry. 2014;55:1479–84.CrossRefGoogle Scholar
  32. 32.
    Safren SA, Bedoya CA, O’Cleirigh C, et al. Treating depression and adherence (CBT-AD) in patients with HIV in care: a three-arm randomized controlled trial. Lancet HIV. 2016;3:e529.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Himelhoch S, Medoff D, Maxfield J, et al. Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS Behav. 2013;17:2756–64.CrossRefGoogle Scholar
  34. 34.
    Magidson JF, Seitz-Brown C, Safren SA, Daughters SB. Implementing behavioral activation and life-steps for depression and HIV medication adherence in a community health center. Cogn Behav Pract. 2014;21:386–403.CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Moitra E, Herbert JD, Forman EM. Acceptance-based behavior therapy to promote HIV medication adherence. AIDS Care. 2011;23:1660–7.CrossRefGoogle Scholar
  36. 36.
    Baler RD, Volkow ND. Drug addiction: the neurobiology of disrupted self-control. Trends Mol Med. 2006;12:559–66.CrossRefGoogle Scholar
  37. 37.
    Tang Y-Y, Posner MI, Rothbart MK, Volkow ND. Circuitry of self-control and its role in reducing addiction. Trends Cogn Sci. 2015;19:439–44.CrossRefGoogle Scholar
  38. 38.
    Tang YY, Yang L, Leve LD, Harold GT. Improving executive function and its neurobiological mechanisms through a mindfulness-based intervention: advances within the field of developmental neuroscience. Child Dev Perspect. 2012;6:361–6.PubMedCentralGoogle Scholar
  39. 39.
    Tang Y-Y, Posner MI. Attention training and attention state training. Trends Cogn Sci. 2009;13:222–7.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Eugene M. Dunne
    • 1
    • 2
    Email author
  • Robert L. Cook
    • 3
  • Nicole Ennis
    • 1
  1. 1.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  2. 2.Department of Psychiatry and Human BehaviorBrown UniversityProvidenceUSA
  3. 3.Departments of Epidemiology and MedicineUniversity of FloridaGainesvilleUSA

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