Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, 9500 Gilman Dr La Jolla, San Diego, CA, 92093, USA.
Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.
J Behav Med. 2024 Dec;47(6):1012-1027. doi: 10.1007/s10865-024-00510-5. Epub 2024 Aug 31.
The Integrated Change Model describes several social and cognitive factors (e.g., health attitudes, social support, self-efficacy) that can affect medication adherence. Guided by this model, we sought to identify profiles of socio-cognitive facilitators of ART (antiretroviral therapy) adherence among diversely minoritized persons living with HIV enrolled in a behavioral intervention trial in Atlanta, Georgia (N = 477). To do this, we performed latent profile analysis on baseline responses to scales assessing 6 indicators of interest: HIV-care self-efficacy, social support, TasP (treatment-as-prevention) beliefs, trust in healthcare providers, perceived need for ART, and trust in ART. We regressed emergent profiles on internalized, enacted, and microaggressive HIV stigma and compared prospective 30-day ART adherence and several cross-sectional HIV outcomes across profiles. Mean age was 29 years; 83% of participants were non-Hispanic Black, 53% were gay/homosexual-identifying, and 12% were gender expansive. Three profiles emerged: "Constrained/Capable" (6%), featuring high self-efficacy but low-moderate provider trust, social support, TasP beliefs, ART trust, and ART need; "Conflicted" (13%), featuring high TasP beliefs, provider trust, and ART need but moderate self-efficacy, ART trust, and social support; and "Motivated" (81%), featuring high levels of all indicators. Greater internalized, enacted, and microaggressive stigma were positively associated with "Conflicted" relative to "Motivated" profile membership. ART-nonadherence, unsuppressed viral load, and viral load unawareness were more likely for the "Conflicted" relative to the "Motivated" profile. Personalized HIV care tailored to such profiles may improve ART adherence and related outcomes for minoritized persons living with HIV.
综合变化模型描述了几个社会和认知因素(例如,健康态度、社会支持、自我效能),这些因素可能会影响药物治疗的依从性。根据该模型,我们试图确定在佐治亚州亚特兰大市参加行为干预试验的多样化少数族裔艾滋病毒感染者中,影响抗逆转录病毒治疗(ART)治疗依从性的社会认知促进因素的特征。为此,我们对基线时评估 6 个感兴趣指标的量表的反应进行了潜在剖面分析:艾滋病毒护理自我效能、社会支持、TasP(治疗即预防)信念、对医疗保健提供者的信任、对 ART 的需求以及对 ART 的信任。我们将新出现的特征与内化、实施和微攻击 HIV 耻辱感进行回归,并比较了不同特征的 30 天内 ART 治疗依从性和几种横断面 HIV 结局。参与者的平均年龄为 29 岁;83%为非西班牙裔黑人,53%为男同性恋/男同性恋者,12%为性别扩张者。出现了三种特征:“受限/有能力”(6%),表现出高自我效能感,但提供者信任度、社会支持、TasP 信念、ART 信任度和 ART 需求较低;“矛盾”(13%),具有较高的 TasP 信念、提供者信任和 ART 需求,但中等自我效能、ART 信任和社会支持;和“积极”(81%),表现出高水平的所有指标。内化、实施和微攻击耻辱感与“矛盾”特征相比,与“积极”特征成员相关。与“积极”特征相比,“矛盾”特征的 ART 不依从、未抑制的病毒载量和病毒载量无知的可能性更高。针对此类特征量身定制的个性化 HIV 护理可能会提高少数族裔 HIV 感染者的 ART 治疗依从性和相关结局。
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