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)

Falls among middle-aged women in the Women’s Interagency HIV Study

To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV− women in the Women's Interagency HIV Study (WIHS)

Adherence, Sexual Risk, and Viral Load in HIV-Infected Women Prescribed Antiretroviral Therapy

The purpose of this study was to determine if there was a connection between adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) in HIV-infected women who were prescribed antiretroviral therapy. The sample consisted of 193 predominately African American women with an average age of 44 who had been on ARV for approximately 9 years and had low annual incomes. All women were participating in a behavioral clinical trial focused on these dual outcomes. Using a risk index developed for this study, we examined the relationship of a composite of risk behaviors to electronically measured and self-reported adherence over the approximately 13-month study period. Women were categorized based on levels of adherence and risky behaviors, and we sought to determine if these classifications were associated with clinical outcomes of HIV viral load and CD4 counts. High levels of adherence were correlated with low risk behaviors (abstinence, consistent use of condoms, etc.). Those classified as high adherence and low-risk behavior (HALR) as well as those classified as high adherence and high-risk behavior (HAHR) had lower mean viral loads and higher CD4 counts than those in the other categories. Women in the low adherence and high-risk category (LAHR) had detectable viral loads and the lowest CD4 counts and are at higher risk for transmitting HIV to partners and unborn children. Our findings underscore the importance of addressing adherence to both ART and RRB in HIV clinical settings to improve clinical outcomes and reduce HIV transmission

Motivational Groups Support Adherence to Antiretroviral Therapy and use of Risk Reduction Behaviors in HIV Positive Nigerian Women: A Pilot Study

Nigerian women comprise the fastest growing group of persons with AIDS in Africa. Antiretroviral therapy has transformed the course of HIV/AIDS to a treatable, chronic illness worldwide. The purpose of this pilot study was to assess the efficacy of a group intervention using motivational interviewing (MI) to promote adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) among HIV-infected women in Nigeria. Recruited participants (n=60) were randomly assigned to the motivational group or the health promotion program (HPP) control group. The 6 month follow-up results indicate that, compared to the control group, MI participants reported significantly higher levels of adherence to ART, higher knowledge of HIV, higher use of condoms/protection during sexual encounters and decision-making not to have sex when no protection was available. The MI participants also had fewer mean number of sexual partners. MI in group format shows promise in promoting adherence to ART and use of RRB in HIV-infected Nigerian women. (Afr J Reprod Health 2012; 16[3]: 14-26).Les femmes nigérianes constituent le groupe de personnes atteintes du sida en Afrique qui s'élargit de manière de plus en plus rapide. La thérapie antirétrovirale a transformé le cours du VIH / SIDA à une maladie soignable et chronique dans le monde entier. Le but de cette étude pilote était d'évaluer l'efficacité d'une intervention de groupe en utilisant l'entrevue de motivation (IM) pour promouvoir l'adhésion à la thérapie antirétrovirale (TAR) et à l'utilisation des comportements de réduction des risques (CRR) parmi les femmes séropositives au Nigéria. Les participantes recrutées (n = 60) ont été assignées aléatoirement au groupe de motivation ou au groupe du programme témoin de la promotion de la santé (PPS). Les résultats complémentaires (n = 48) indiquent que par rapport au groupe témoin, les participantes de l'IM ont signalé les niveaux significativement plus élevés de l'adhésion à la TAR, un niveau plus élevé de connaissance du VIH, une plus grande utilisation du préservatif ou de protection lors de rapports sexuels et la prise de décision de ne pas avoir des rapports sexuels et la prise de décision de ne pas avoir des rapports sexuels quand il n'y a pas de protection. Les participantes de l'IM avaient également moins du nombre moyen de partenaires sexuels. L'IM en format de groupe est prometteur quand il s'agit de l'adhésion à la TAR et à l'utilisation de CRR chez les femmes nigérianes séropositives (Afr J Reprod Health 2012; 16[3]: 14-26)

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

Longitudinal Study of Falls among HIV-infected and Uninfected Women: The Role of Cognition

BACKGROUND: Although fracture rates are higher in HIV+ than HIV- women, whether HIV infection increases risk of falls is unclear. We determined the longitudinal occurrence and risk factors for falls in the Women\u27s Interagency HIV Study (WIHS), and explored associations with cognitive complaints. METHODS: Recent (prior 6 months) self-reported falls were collected in 1,816 (1,250 HIV+; 566 HIV-) women over 24 months. Generalized estimating equation models using stepwise selection determined odds of any fall (versus none). RESULTS: HIV+ women were older than HIV- women (median 49 versus 47 years; P=0.0004), more likely to report neuropathy (20% versus 16%; P=0.023), and had greater central nervous system (CNS) medication use. At least one fall was reported in 41% HIV+ versus 42% HIV- women, including \u3e/=2 falls in 25% HIV+ and 24% HIV- (overall P=0.30). Cognitive complaints were associated with falls among HIV+ (odds ratio [OR] 2.38; 95% CI 1.83, 3.09) and HIV- women (OR 3.43; 95% CI 2.37, 4.97); in adjusted models, cognitive complaints remained significant only in HIV- women (adjusted [aOR] 2.26; 95% CI 1.46, 3.48). Factors associated with any fall in adjusted analyses included: depressive symptoms and neuropathy (both HIV+ and HIV-); age, marijuana use, multiple CNS medications, and HCV infection (HIV+ only); and cognitive complaints, quality of life, hypertension and obesity (HIV- only). CONCLUSIONS: Middle-aged HIV+ and HIV- women had similar fall rates. Among HIV+ women, factors affecting cognition such as age, depressive symptoms, marijuana use and multiple CNS medications were important predictors of falls, however, cognitive complaints were not

Impaired Cognition Predicts Falls Among Women With and Without HIV Infection

Objective: To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV- women. Design: Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women\u27s Interagency HIV Study with NC testing within 2 years before falls surveys. Methods: NC impairment (T score \u3c40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P \u3c 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors. Results: Median age was higher in HIV+ than HIV- women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened and remained significant. Conclusions: Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women and how different factors modify relationships between cognition and falls

Falls among middle-aged women in the Women’s Interagency HIV Study

OBJECTIVE: To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV− women in the Women's Interagency HIV Study (WIHS). METHODS: We quantified self-report of any and multiple (≥2 falls) in the prior 6 months among 1,412 HIV+ and 650 HIV− women with mean age 48 years. Logistic regression was used to evaluate associations of demographics, behavioral factors, comorbid conditions, and medications with odds of any fall (vs. none) and multiple falls (vs. ≤1 fall). RESULTS: At least one fall was reported in 263 HIV+ (19%) vs. 119 HIV− (18%) women, and ≥2 falls reported in 133 HIV+ (9%) vs. 65 HIV− (10%) women. HIV infection was not associated with falls in multivariate analyses. Factors independently associated with any fall included age (aOR 1.71, 95% CI:1.17-2.49 age 50-59 vs. <39y; aOR 2.26, 95% CI:1.38-3.71 age ≥60 vs. <39), current marijuana use (aOR 2.19, 95% CI:1.53-3.13) depressive symptoms (aOR 1.57, 95% CI:1.21-2.05 for CES-D ≥16), subjective cognitive complaints (aOR 2.19, 95% CI:1.56-3.08), neuropathy (aOR 1.59, 95% CI:1.19-2.13), obesity (aOR 1.39, 95% CI:1.08-1.80), number of CNS active agents (aOR 2.98, 95% CI:1.90-4.68 for ≥3 agents vs. 0) and WIHS site. Factors associated with ≥2 falls included age, marijuana use, number of CNS active agents, subjective cognitive complaints, depressive symptoms, neuropathy, and study site. CONCLUSIONS: Falls were associated with factors affecting cognition, but not HIV status in this large cohort of women. Longitudinal studies are needed to determine the incidence and consequences of falls by HIV status as women age

Polypharmacy Is Associated With Falls in Women With and Without HIV

BACKGROUND: Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV-). METHODS: Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH and 557 HIV-) Women\u27s Interagency HIV Study participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS: The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51% vs. 41%; P \u3c 0.001) and NCAE medication use (44% vs. 37%; P = 0.01) than HIV- women. Polypharmacy conferred elevated odds of single fall [adjusted odds ratio (aOR) 1.67, 95% CI: 1.36 to 2.06; P \u3c 0.001] and multiple falls (aOR 2.31, 95% CI: 1.83 to 2.93; P \u3c 0.001); the results for NCAE medications and falls were similar. Both polypharmacy and number of NCAE medications remained strongly and independently associated with falls in multivariable models adjusted for HIV serostatus, study site, sociodemographics, clinical characteristics, and substance use. CONCLUSIONS: Polypharmacy and NCAE medication use were greater among WWH compared with HIV-, and both were independently and incrementally related to falls. Deprescribing and avoidance of medications with NCAEs may be an important consideration for reducing fall risk among WWH and sociodemographically similar women without HIV