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
