Kalichman Seth C, Kalichman Moira O
Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
J Clin Psychol Med Settings. 2016 Dec;23(4):420-430. doi: 10.1007/s10880-016-9481-8.
HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.
艾滋病病毒治疗依赖于高水平的抗逆转录病毒疗法（ART）依从性，而贫困严重阻碍了这种依从性。92名感染艾滋病病毒的男性和女性完成了关于人口统计学和健康特征、贫困指标、压力性生活事件、生活混乱状况的计算机化访谈，以及用于确定未来药物依从性的突击药丸计数和艾滋病病毒载量的病历图表摘要。贫困指标与压力源和混乱状况都有关联，这三个因素的直接影响都预示着抗逆转录病毒疗法的不依从。多重中介模型表明，考虑压力源和混乱状况后，贫困指标与抗逆转录病毒疗法依从性之间的关联不再显著。贫困指标通过生活混乱状况对依从性产生的间接影响显著，而贫困指标通过压力源对依从性产生的间接影响不显著。造成与艾滋病病毒相关压力并导致生活混乱的因素提供了比贫困本身更易于改变的干预目标。
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