title: Psychological factors, beliefs about medication, and adherence of youth with human immunodeficiency virus in a multisite directly observed therapy pilot study.
abstract: This study examined psychological functioning and beliefs about medicine in adolescents with human immunodeficiency virus (HIV) on highly active antiretroviral therapy in a community-based directly observed therapy (DOT) pilot feasibility study. Participants were youth with behaviorally acquired HIV (n = 20; 65% female; median age, 21 years) with adherence problems, who received once-daily DOT. Youth were assessed at baseline, week 12 (post-DOT), and week 24 (follow-up). At baseline, 55% of youth reported having clinical depressive symptoms compared to 27% at week 12 with sustained improvements at week 24. At baseline, substance use was reported within the borderline clinical range (T(score) = 68), with clinical but statistically nonsignificant improvement (T(score) = 61) at week 12. Hopelessness scores reflected optimism for the future. Coping strategies showed significantly decreased cognitive avoidance (p = .02), emotional discharge (p = .004), and acceptance/resignation ("nothing I can do," p = .004), whereas positive reappraisal and seeking support emerged. With the exception of depressive symptoms, week 12 improvements were not sustained at week 24. DOT adherence was predicted by higher baseline depression (p = .05), beliefs about medicine (p = .006) and perceived threat of illness scores (p = .03). Youth with behaviorally acquired HIV and adherence problems who participated in a community-based DOT intervention reported clinically improved depressive symptoms, and temporarily reduced substance use and negative coping strategies. Depressive symptoms, beliefs about medicine, and viewing HIV as a potential threat predicted better DOT adherence.
authors.affiliation: Department of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. patti.garvie@stjude.org
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Marvin
authors.initials: M
authors.lastname: Belzer
authors.forename: Paula
authors.initials: P
authors.lastname: Britto
authors.forename: Chengcheng
authors.initials: C
authors.lastname: Hu
authors.forename: Bobbie
authors.initials: B
authors.lastname: Graham
authors.forename: Michael
authors.initials: M
authors.lastname: Neely
authors.forename: George D
authors.initials: GD
authors.lastname: McSherry
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Spector
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D023801:Directly Observed Therapy / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult