Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men
Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men
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DOI：
10.1186/s12981-019-0248-9
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发表时间：
2019-11-09
影响因子：
2.2
通讯作者：
Simmons, Janie
中科院分区：
文献类型：
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作者：
McMahon, James M.;Braksmajer, Amy;Simmons, Janie
背景HIV抗逆转录病毒治疗(ART)的依从性不佳以及伴随而来的病毒控制的缺乏可能会对HIV感染者的健康和继续传播造成严重后果。人们对异性恋HIV阳性男性接受最佳抗逆转录病毒治疗的障碍和促进者知之甚少。方法采用结构方程模型(SEM)对居住在纽约市的317名HIV阳性的自我确认的异性恋男性的横断面样本数据进行ART依从性的理论模型检验。我们评估了一个概念性模型，在该模型中，精神健康(抑郁、焦虑)和物质使用依赖中介了社会结构因素(艾滋病毒相关的耻辱、社会支持)对抗逆转录病毒治疗依从性的影响，并随后导致了无法检测到的病毒载量。结果结构方程模型分析表明，报告艾滋病毒相关污名水平较高的男性倾向于经历更高水平的一般焦虑，这反过来与最佳抗逆转录病毒治疗依从性的可能性降低有关。此外，报告社会支持水平较高的男性倾向于表现出对非法药物使用的较少依赖，这反过来与最佳抗逆转录病毒治疗依从性的可能性增加有关。非洲裔美国男性报告说，与其他种族/民族相比，他们对艺术的依从性较低。结论我们的研究结果支持这一假设，即物质使用依赖和精神健康问题，特别是焦虑，可能是异性恋男性对ART依从性不佳的主要驱动因素，而社会结构性因素，如HIV相关的耻辱和社会支持，可能是这些驱动因素的可修改的前置因素。
Background Suboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men. Methods Structural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load. Results Structural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups. Conclusions Our findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.