Psychosocial impact of poverty on antiretroviral nonadherence among HIV-TB coinfected patients in Lima, Peru.
OBJECTIVE
Tuberculosis and HIV coinfection poses unique clinical and psychosocial complexities that can impact nonadherence to highly active antiretroviral treatment (HAART).


METHODS
This was a prospective case series to identify risk factors for HAART nonadherence among 43 patients with HIV and tuberculosis (TB) in Lima, Peru. Nonadherence was defined by patient self-report.


RESULTS
The median initial CD4 and HIV viral load were 63 and 159,000, respectively. Patients had received a median of 6.1 months of ART. Univariable analysis found low social support, substance use, and depression to be associated with nonadherence. In multivariable analysis, low social support was associated with nonadherence.


CONCLUSIONS
In the authors' urban cohort of HIV-TB coinfected individuals in Lima, Peru, substance use, depression, and lack of social support were key barriers to adherence. These findings suggest that adherence interventions may be unsuccessful unless they target the underlying psychosocial challenges faced by patients living with TB and AIDS.
Shin
Sonya
S
Brigham and Women's Hospital, Division of Social Medicine and Health Inequalities, Boston, MA 02115, USA. sshin@partners.org
Muñoz
Maribel
M
Espiritu
Betty
B
Zeladita
Jhon
J
Sanchez
Eduardo
E
Callacna
Miriam
M
Rojas
Christian
C
Arevalo
Jorge
J
Wu
Ying
Y
Caldas
Adolfo
A
Sebastian
Jose Luis
JL
D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010568:Peru; D011203:Poverty; D011584:Psychology; D012307:Risk Factors; D012944:Social Support; D014376:Tuberculosis / Q000150:complications*; D055815:Young Adult