title: Psychosocial impact of poverty on antiretroviral nonadherence among HIV-TB coinfected patients in Lima, Peru.
abstract: 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.
authors.affiliation: Brigham and Women's Hospital, Division of Social Medicine and Health Inequalities, Boston, MA 02115, USA. sshin@partners.org
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.forename: Maribel
authors.initials: M
authors.lastname: Muñoz
authors.forename: Betty
authors.initials: B
authors.lastname: Espiritu
authors.forename: Jhon
authors.initials: J
authors.lastname: Zeladita
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sanchez
authors.forename: Miriam
authors.initials: M
authors.lastname: Callacna
authors.forename: Christian
authors.initials: C
authors.lastname: Rojas
authors.forename: Jorge
authors.initials: J
authors.lastname: Arevalo
authors.forename: Ying
authors.initials: Y
authors.lastname: Wu
authors.forename: Adolfo
authors.initials: A
authors.lastname: Caldas
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Sebastian
mesh_terms: 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