Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
J Acquir Immune Defic Syndr. 2020 Apr 1;83(4):340-344. doi: 10.1097/QAI.0000000000002268.
Depression plays a key role in suboptimal HIV outcomes, possibly mediated by adherence self-efficacy beliefs and antiretroviral treatment (ART) adherence behavior. Applying social-cognitive theory, we examined a longitudinal sequential path model of the association between depressive symptoms and viral nonsuppression in women with HIV (WWH) through these mediating mechanisms.
This was an observational longitudinal study using data from the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. WWH (N = 375) completed measures of depressive symptoms, adherence self-efficacy, and ART adherence. Viral load was measured through blood draw. We examined a longitudinal sequential path model spanning 3 time points at least 6 months apart between 2015 and 2017. Indirect effects were assessed of depressive symptoms at time 1 (T1) on viral nonsuppression at T3 through adherence self-efficacy at T2 and ART adherence at T3. Covariates included age, income, recreational drug use, race, and months on ART.
Depressive symptoms were associated with subsequent viral nonsuppression through its association with adherence self-efficacy and ART adherence [indirect effect: adjusted odds ratio = 1.004, 95% confidence interval: (1.001 to 1.008)]. Months on ART and recreational drug use were also significantly associated with viral nonsuppression at T3.
Our findings support depressive symptoms' association with adherence self-efficacy that in turn lead to suboptimal ART adherence and ultimately to viral nonsuppression for WWH. Tailoring of interventions aimed at addressing depressive symptoms, substance use, and adherence self-efficacy among WWH is needed to help close the gap between ART prescription and viral suppression on the HIV care continuum.
抑郁在 HIV 治疗效果不佳中起着关键作用，其作用机制可能是通过依从性自我效能信念和抗逆转录病毒治疗（ART）依从性行为。本研究应用社会认知理论，通过这些中介机制，检验了 HIV 女性（WWH）抑郁症状与病毒载量未抑制之间的纵向序列路径模型。
这是一项观察性纵向研究，使用了 Women's Interagency HIV Study 中 Women's Adherence and Visit Engagement 子研究的数据。WWH（N=375）完成了抑郁症状、依从性自我效能和 ART 依从性的评估。通过采血测量病毒载量。我们在 2015 年至 2017 年间，至少相隔 6 个月，共进行了 3 个时间点的纵向序列路径模型检验。在 T1 时，抑郁症状对 T3 时的病毒载量未抑制的间接效应，是通过 T2 时的依从性自我效能和 T3 时的 ART 依从性来体现的。协变量包括年龄、收入、消遣性药物使用、种族和接受 ART 治疗的时间。
抑郁症状与随后的病毒载量未抑制相关，其相关因素为依从性自我效能和 ART 依从性[间接效应：调整后的比值比=1.004，95%置信区间：（1.001 至 1.008）]。接受 ART 治疗的时间和消遣性药物使用也与 T3 时的病毒载量未抑制显著相关。
本研究结果支持抑郁症状与依从性自我效能的相关性，而依从性自我效能又与 ART 依从性相关，最终导致 WWH 的 ART 依从性不佳，进而导致病毒载量未抑制。需要针对 WWH 制定干预措施，以解决抑郁症状、药物使用和依从性自我效能问题，从而缩小 HIV 治疗连续体中 ART 处方与病毒抑制之间的差距。
