Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa: a prospective cohort study

Ingrid T. Katz, Laura M. Bogart, Janan J. Dietrich, Hannah H. Leslie, Hari S. Iyer, Dominick Leone, Jessica F. Magidson, Valerie A. Earnshaw, Ingrid Courtney, Gugu Tshabalala, Garrett M. Fitzmaurice, Catherine Orrell, Glenda Gray, David Bangsberg

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)S71-S79
JournalAIDS (London, England)
Volume33
DOIs
StatePublished - Jun 1 2019

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Katz, I. T., Bogart, L. M., Dietrich, J. J., Leslie, H. H., Iyer, H. S., Leone, D., Magidson, J. F., Earnshaw, V. A., Courtney, I., Tshabalala, G., Fitzmaurice, G. M., Orrell, C., Gray, G., & Bangsberg, D. (2019). Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa: a prospective cohort study. AIDS (London, England), 33, S71-S79. https://doi.org/10.1097/QAD.0000000000002175