Health literacy: impact on the health of HIV-infected individuals.

Health literacy is known to affect vulnerable communities such as persons living with HIV/AIDS. The purpose of this review was to provide a current summary of research on the impact of health literacy on the health of persons living with HIV/AIDS and to address future areas of need. Contemporary studies focused on expanding the reach of health literacy in HIV/AIDS to retention in HIV care, use of technology for assessing and intervening to improve health literacy, and health literacy across the globe, for example. A number of studies did not find health literacy to explain health behaviors whereas other studies supported such a relationship. Future issues relevant to health literacy in HIV/AIDS include the aging of the HIV population and associated comorbidities, studies to understand the role of health literacy in specific populations affected by HIV/AIDS, and the continued need to refine the definition and measurement of health literacy

Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates

Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (p\u3c 0.05). Social support satisfaction was also significantly associated with ART adherence (OR = 1.52, 95% CI [1.11–2.08], p \u3c 0.05) and energy/fatigue/vitality (OR = 1.03, 95% CI [1.00–1.05], p \u3c 0.05)

Factors Associated With Antiretroviral Therapy Nondherence In Older Adults With HIV

Thesis (Ph.D.)--University of Washington, 2012University of Washington Abstract Factors Associated With Antiretroviral Therapy Nonadherence in Older Adults With HIV by Katryna Floyd McCoy Chair of the Supervisory Committee: Professor David G. Allen, PhD, FAAN Department Chair, Gender, Women and Sexuality Studies Professor, Psychosocial and Community Health Nursing The advent of antiretroviral therapy (ART) has contributed to a significant decrease in the number of deaths resulting from HIV/AIDS infections. Despite the decline in mortality rates for the total population of those infected with HIV, adults aged 50 years and older who are HIV+ have continued to have higher mortality when compared to younger HIV+ persons. This disparity exists in part because of inadequate adherence. However, the reasons for this disparity have not been fully evaluated, particularly among older women. The purpose of this study was to describe the factors associated with antiretroviral therapy nonadherence and treatment adherence self-efficacy in HIV+ adults aged 50 years and older. The specific aims are to: (1) Describe the demographic, HIV disease-specific and psychosocial factors associated with adherence outcomes in African American women aged 50 years and older who are infected with HIV and are nonadherent to ART regimens. (2) Describe gender or racialized differences in factors associated with adherence outcomes in older HIV+ African American women compared to other older adults who are HIV+. This descriptive study involved a secondary analysis of baseline data collected from the 426 African American (n = 87 women and 168 men) and White American ( n = 30 women and 141 men) participants in the "PRIME" study (Dr. Sheryl Catz, PI), a telephone-based antiretroviral therapy adherence and quality of life intervention in older Americans living with HIV. Predictor variables for this analysis included demographic factors, HIV disease-related factors, and psychosocial factors. Dependent variables included primarily, self-reported 7 day ART nonadherence and secondarily, treatment adherence self-efficacy. Cross-sectional data analysis involved descriptive statistics, comparisons and analysis of covariance (ANCOVA) using SPSS. Although African American women had the highest levels of ART nonadherence, their levels of nonadherence were not statistically different than the other ethnic/gender groups. The level of ART nonadherence was strongly correlated with social functioning, perceived stress and depression severity in the men. Treatment self-efficacy was strongly correlated with social functioning, depression and patient-provider interactions across each of the groups. Neither ethnic nor gender differences contributed to the differences in ART nonadherence or treatment self-efficacy across the groups

Correlates of Antiretroviral Therapy Adherence among HIV-Infected Older Adults

BackgroundDespite the success of antiretroviral therapy (ART), HIV-infected older African Americans experience higher mortality rates compared to their white counterparts. This disparity may be partly attributable to the differences in ART adherence by different racial and gender groups. The purpose of this study was to describe demographic, psychosocial, and HIV disease-related factors that influence ART adherence and to determine whether race and gender impact ART adherence among HIV-infected adults aged 50 years and older.MethodsThis descriptive study involved a secondary analysis of baseline data from 426 participants in "PRIME," a telephone-based ART adherence and quality-of-life intervention trial. Logistic regression was used to examine the association between independent variables and ART adherence.ResultsHigher annual income and increased self-efficacy were associated with being ≥95% ART adherent. Race and gender were not associated with ART adherence.ConclusionThese findings indicated that improvements in self-efficacy for taking ART may be an effective strategy to improve adherence regardless of race or gender

Cessation-related information, motivation, and behavioral skills in smokers living with HIV

There is a need for new, targeted smoking cessation interventions for smokers living with HIV. The Information-Motivation-Behavioral Skills (IMB) model has been applied effectively to HIV-related health behaviors and was used in this qualitative study to elicit factors that could lead to the development of innovative and successful cessation interventions for this population. Twenty individuals who smoked from two clinics providing care to people living with HIV participated in open-ended interviews, responding to questions covering the domains of the IMB model, as applied to smokers living with HIV. Participants were enrolled from a larger survey cohort to recruit into groups based on the impact of HIV diagnosis on smoking as well as attempting to enroll a mix of demographics characteristics. Interviews were recorded, transcribed, coded and thematically analyzed using a grounded theory qualitative approach. Interviews continued until thematic saturation was reached. Major themes included: Presence of knowledge deficits regarding HIV-specific health risks of smoking; use of smoking for emotional regulation, where many reported close contacts who smoke and concern with the effect of cessation on their social networks; Use of smoking cessation aids or a telephone-based wellness intervention were acceptable to most. Providing HIV-specific information in cessation advice is of the utmost importance for clinicians caring for smokers living with HIV, as this theme was noted consistently as a potential motivator to quit. Innovative and effective interventions must account for the social aspect of smoking and address other methods of emotional regulation in this population

Correlates of Antiretroviral Therapy Adherence among HIV-Infected Older Adults

Background: Despite the success of antiretroviral therapy (ART), HIV-infected older African Americans experience higher mortality rates compared to their white counterparts. This disparity may be partly attributable to the differences in ART adherence by different racial and gender groups. The purpose of this study was to describe demographic, psychosocial, and HIV disease-related factors that influence ART adherence and to determine whether race and gender impact ART adherence among HIV-infected adults aged 50 years and older. Methods: This descriptive study involved a secondary analysis of baseline data from 426 participants in “PRIME,” a telephone-based ART adherence and quality-of-life intervention trial. Logistic regression was used to examine the association between independent variables and ART adherence. Results: Higher annual income and increased self-efficacy were associated with being ≥95% ART adherent. Race and gender were not associated with ART adherence. Conclusion: These findings indicated that improvements in self-efficacy for taking ART may be an effective strategy to improve adherence regardless of race or gender

Alcohol and Associated Characteristics among Older Persons Living with Human Immunodeficiency Virus on Antiretroviral Therapy

BackgroundAlcohol use, and particularly unhealthy alcohol use, is associated with poor human immunodeficiency virus (HIV)-related outcomes among persons living with HIV (PLWH). Despite a rapidly growing proportion of PLWH ≥50 years, alcohol use and its associated characteristics are underdescribed in this population. The authors describe alcohol use, severity, and associated characteristics using data from a sample of PLWH ≥50 years who participated in a trial of a telephone-based intervention to improve adherence to antiretroviral therapy (ART).MethodsParticipants were recruited from acquired immunodeficiency syndrome (AIDS) service organizations in 9 states and included PLWH ≥50 years who were prescribed ART, reported suboptimal adherence at screening (missing >1.5 days of medication or taking medications 2 hours early or late on >3 days in the 30 days prior to screening), and consented to participate. The AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) alcohol screen, sociodemographic characteristics, substance use, and mental health comorbidity were assessed at baseline. AUDIT-C scores were categorized into nondrinking, low-level drinking, and mild-moderate unhealthy, and severe unhealthy drinking (0, 1-3, 4-6, and 7-12, respectively). Analyses described and compared characteristics across drinking status (any/none) and across AUDIT-C categories among drinkers.ResultsAmong 447 participants, 57% reported drinking in the past year (35%, 15%, and 7% reported low-level drinking, mild-moderate unhealthy drinking, and severe unhealthy drinking, respectively). Any drinking was most common among men and those who were lesbian, gay, bisexual, or transgender (LGBT), married/partnered, had received past-year alcohol treatment, and never used injection drugs (P values all <.05). Differences in race, employment status, past-year alcohol treatment, and positive depression screening (P values all <.05) were observed across AUDIT-C categories, with African American race, less than full-time employment, past-year alcohol treatment, and positive depression screening being most common among those with the most severe unhealthy drinking.ConclusionsIn this sample of older PLWH with suboptimal ART adherence, a majority reported past-year alcohol use and 22% screened positive for unhealthy alcohol use. Any and unhealthy alcohol use were associated with demographics, depression, and substance use history. Further research is needed regarding alcohol use among older PLWH

Correlates and Predictors of Medication Adherence in Outpatients Living with HIV/AIDS

Antiretroviral therapy (ART) is important in HIV outcomes and HIV prevention. However, ART adherence remains suboptimal in people living with HIV/AIDS (PLWH). This study examined associations among ART adherence and demographic, psychosocial, and religious factors in a sample of 292 PLWH. Average age of participants was 45.1 ± 7.8 years and they had been living with HIV for 10.8 ± 7.0 years, on average. Mean ART adherence scores differed significantly between participants based on age (F = 5.861, p = .016), depressive symptom status (F = 17.61, p \u3c .0001), religious attendance (F = 5.901, p = .016), and prayer (F = 5.791, p = .017). Only age, social support, prayer, and negative religious coping were significant predictors of ART adherence, in a multivariate regression model. Higher ART adherence scores were significantly associated with being older than 50 years (β = .17, p = .014), greater social support satisfaction (β = .15, p = .031), praying daily or more (β = .17, p = .021) and lower negative religious coping scores (β = −.18, p = .014). Clinicians should assess/address these factors during ART treatment counseling