TY - JOUR
T1 - Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa
T2 - A prospective cohort study
AU - Katz, Ingrid T.
AU - Bogart, Laura M.
AU - Dietrich, Janan J.
AU - Leslie, Hannah H.
AU - Iyer, Hari S.
AU - Leone, Dominick
AU - Magidson, Jessica F.
AU - Earnshaw, Valerie A.
AU - Courtney, Ingrid
AU - Tshabalala, Gugu
AU - Fitzmaurice, Garrett M.
AU - Orrell, Catherine
AU - Gray, Glenda
AU - Bangsberg, David R.
N1 - Funding Information: The publication was made possible with funding from US National Institute for Mental Health K23 MH097667 (I.T.K.). J.F.M. and V.A.E.’s time spent on this article was supported by the US National Institute on Drug Abuse (K23DA041901, K01DA042881). L.M.B.’s time was also supported by P30MH058107 from the US National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article. Publisher Copyright: © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Objective: Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90 90 90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention. Design: Prospective cohort study. Methods: From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors. Results: Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89 0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00 1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65 0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02 1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00 1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77 0.92), compared with those who initiated ART but did not achieve plasma RNA suppression. Conclusion: Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.
AB - Objective: Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90 90 90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention. Design: Prospective cohort study. Methods: From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors. Results: Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89 0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00 1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65 0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02 1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00 1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77 0.92), compared with those who initiated ART but did not achieve plasma RNA suppression. Conclusion: Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.
KW - Coping
KW - Hiv
KW - Resilience resources
KW - Social support
KW - South africa
UR - https://www.scopus.com/pages/publications/85063722017
UR - https://www.scopus.com/pages/publications/85063722017#tab=citedBy
U2 - 10.1097/QAD.0000000000002175
DO - 10.1097/QAD.0000000000002175
M3 - Article
C2 - 31397725
SN - 0269-9370
VL - 33
SP - S71-S79
JO - AIDS
JF - AIDS
ER -