title: Psychosocial mediators of antiretroviral nonadherence in HIV-positive adults with substance use and mental health problems.
abstract: This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations.
authors.affiliation: RAND Corporation, Santa Monica, CA 90407-2138, USA. joan_tucker@rand.org
authors.forename: Joan S
authors.initials: JS
authors.lastname: Tucker
authors.forename: Maria
authors.initials: M
authors.lastname: Orlando
authors.forename: M Audrey
authors.initials: MA
authors.lastname: Burnam
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Fuan-Yue
authors.initials: FY
authors.lastname: Kung
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011584:Psychology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D044966:Anti-Retroviral Agents; D015704:CD4 Antigens