title: Medication beliefs and structural barriers to treatment adherence among people living with HIV infection.
abstract: BACKGROUND
  People living in poverty face multiple structural challenges to medication adherence including lack of transportation, inadequate housing and food insecurity. The degree to which individuals' motivations to remain adherent may overcome structural barriers has received limited attention.
  
  
  OBJECTIVE
  To examine whether medication necessity and concerns beliefs predict antiretroviral therapy (ART) adherence over and above structural adherence barriers associated with poverty.
  
  
  METHODS
  People living with HIV in a southern US city (N = 942) completed computerised interviews, an objective measure of adherence and HIV viral suppression obtained from medical records. Hierarchical logistic regression models were constructed to examine demographic and illness characteristics, structural barriers, mental health, substance use and medication necessity and concerns beliefs as predictors of ART adherence.
  
  
  RESULTS
  In multivariable models, current drug use and medication necessity and concerns beliefs predicted treatment adherence over and above demographic, health, mental health and structural factors.
  
  
  CONCLUSIONS
  Medication beliefs are proximal and powerful motivating factors that predict adherence. Adherence interventions should directly address medication beliefs in developing strategies to manage barriers facing people with HIV living in poverty.
authors.affiliation: a Department of Psychology , University of Connecticut , Storrs , CT , USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Kalichman
authors.affiliation: a Department of Psychology , University of Connecticut , Storrs , CT , USA.
authors.forename: Moira O
authors.initials: MO
authors.lastname: Kalichman
authors.affiliation: a Department of Psychology , University of Connecticut , Storrs , CT , USA.
authors.forename: Chauncey
authors.initials: C
authors.lastname: Cherry
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D015999:Multivariate Analysis; D011203:Poverty; D019966:Substance-Related Disorders / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV-AIDS; medication adherence; medicines necessity-concerns beliefs; poverty; structural barriers