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 - 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 - http://www.scopus.com/inward/record.url?scp=85063722017&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063722017&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000002175
DO - 10.1097/QAD.0000000000002175
M3 - Article
C2 - 31397725
AN - SCOPUS:85063722017
SN - 0269-9370
VL - 33
SP - S71-S79
JO - AIDS
JF - AIDS
ER -