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Published Online: 13 February 2023

High Psychosocial Burden Relates to Poorer Antiretroviral Treatment Adherence Among Black/African American People with HIV

Publication: AIDS Patient Care and STDs
Volume 37, Issue Number 2

Abstract

Black/African American communities continue to be disproportionately impacted by HIV with Black people with HIV (PWH) exhibiting poorer outcomes along the HIV treatment cascade. Psychosocial burden may, in part, explain these health disparities among PWH. We implemented a culturally adapted intervention [individualized Texting for Adherence Building (iTAB)] to improve ART adherence among 89 Black PWH in San Diego, CA. We aimed to (1) characterize psychosocial risk factors (depression, negative life events, discrimination, medical mistrust) hypothesized to be barriers to HIV outcomes among Black PWH and (2) determine if these factors influence intervention engagement, HIV outcomes, and self-reported physical and mental health. We identified three levels of psychosocial burden (low, moderate, high) through hierarchical cluster analysis. Participants in the high burden cluster (n = 25) experienced the highest levels of depression, negative life events, and discrimination, in addition to the poorest intervention outcomes, HIV outcomes, and physical and mental health compared to low and moderate burden clusters. Participants in the low (n = 29) burden cluster had less medical mistrust than the moderate (n = 34) and high burden clusters, but low and moderate clusters did not differ on any outcomes. Overall, self-reported ART adherence was 83%, which is above estimates of ART adherence in the Western region of the United States. The iTAB intervention shows promise in improving HIV-related outcomes among Black PWH with low to moderate psychosocial burden; however, additional supports may need to be identified for those with high psychosocial burden.

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cover image AIDS Patient Care and STDs
AIDS Patient Care and STDs
Volume 37Issue Number 2February 2023
Pages: 103 - 113
PubMed: 36689195

History

Published online: 13 February 2023
Published in print: February 2023
Published ahead of print: 24 January 2023

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HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
Jessica L. Montoya
HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
Department of Psychiatry and University of California San Diego, La Jolla, California, USA.
Vanessa Serrano
HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
Samantha Yeager
HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
Department of Medicine, University of California San Diego, La Jolla, California, USA.
Dafna Paltin
HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
Elizabeth C. Pasipanodya
Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California, USA.
Maria J. Marquine
Geriatrics Division, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Martin Hoenigl
Department of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Medicine, Medical University of Graz, Graz, Austria.
Christian B. Ramers
Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA.
John Kua
Laura Rodriguez Research Institute, Family Health Centers, San Diego, California, USA.
David J. Moore [email protected]
HIV Neurobehavioral Research Program, UC San Diego, San Diego, California, USA.
Department of Psychiatry and University of California San Diego, La Jolla, California, USA.

Notes

Address correspondence to: David J. Moore, PhD, HIV Neurobehavioral Research Program, University of California San Diego, 220 Dickinson Street, Suite B (8231), San Diego, CA 92103, USA [email protected]

Authors' Contributions

L.H. contributed to the conceptualization, methodology, formal analysis, investigation, writing—original draft, writing—review and editing, and visualization. J.L.M. contributed to the conceptualization, methodology, and writing—review and editing. V.S. contributed to the writing—original draft, and writing—review and editing. S.Y. contributed to the writing—original draft, and writing—review and editing, D.P. contributed to the writing—original draft, and writing—review and editing. E.C.P. contributed to the conceptualization, methodology, and writing—review and editing. M.J.M. contributed to the conceptualization, methodology, and writing—review and editing. M.H. contributed to the conceptualization, methodology, and writing—review and editing. C.B.R. contributed to the conceptualization and writing—review and editing. J.K. contributed to the conceptualization and writing—review and editing, D.J.M. contributed to the conceptualization, methodology, and writing—review and editing.

Author Disclosure Statement

M.H. received funding from Gilead, Merck Sharpe & Dohme (MSD), Pfizer and National Institutes of Health (NIH). No other authors have disclosures/conflicts of interests.

Funding Information

This work was supported by the California HIV Research Program (CHRP: HD15-SD-059). L.H. was supported by the National Science Foundation (NSF) Graduate Research Fellowship Program (GRFP): 2038238. S.Y. was supported by the NIDA: R01 DA049644-S1 and L30 DA056940. J.L.M. was supported by NIDA K23DA051324.

Ethical Approval

This research was reviewed and approved by the UC San Diego IRB.

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