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

Authors

Ingrid T. Katz, Harvard Medical SchoolFollow
Laura M. Bogart, RAND Corporation
Janan J. Dietrich, University of the Witwatersrand
Hannah H. Leslie, Harvard T.H. Chan School of Public Health
Hari S. Iyer, Harvard T.H. Chan School of Public Health
Dominick Leone, Brigham and Women's Hospital
Jessica Magidson, University of Maryland
Valerie A. Earnshaw, University of Delaware
Ingrid Courtney, University of Cape Town Medical SchoolFollow
Gugu Tshabalala, University of the Witwatersrand
Garrett M. Fitzmaurice, Harvard Medical SchoolFollow
Catherine Orrell, University of Cape Town Medical SchoolFollow
Glenda Gray, University of the Witwatersrand
David R. Bangsberg, Portland State UniversityFollow

Published In

Aids

Document Type

Citation

Publication Date

6-1-2019

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 (/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.

Description

Copyright © 2019 Wolters Kluwer Health, Inc.

Locate the Document

http://doi.org/10.1097/QAD.0000000000002175

DOI

10.1097/QAD.0000000000002175

Persistent Identifier

https://archives.pdx.edu/ds/psu/30068

Citation Details

Katz, I. T., Bogart, L. M., Dietrich, J. J., Leslie, H. H., Iyer, H. S., Leone, D., ... & Fitzmaurice, G. M. (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, 33, S71-S79.