title: Psychosocial factors in adherence to antiretroviral therapy among HIV-positive people who use drugs.
abstract: OBJECTIVE
  Suboptimal adherence to antiretroviral therapy (ART) among HIV-infected people who use illicit drugs (PWUD) remains a significant concern, and there is a lack of effective adherence interventions for this population. Therefore, we sought to identify psychosocial determinants of optimal adherence, including adherence self-efficacy and outcome expectancies, with the aim of informing interventions designed to improve adherence among PWUD.
  
  
  METHODS
  From December 2005 to November 2013, we collected data from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), a prospective cohort of PWUD in Vancouver, Canada. We used multivariable generalized estimating equations (GEE) analysis to identify longitudinal factors independently associated with 95% or greater adherence to ART.
  
  
  RESULTS
  Among 667 participants, including 220 (33%) women, 391 (59%) had 95% or greater ART adherence at baseline. In multivariable GEE analysis, adherence self-efficacy, adjusted odds ratio (AOR) = 1.16, 95% confidence interval (CI) [1.11, 1.21] per 10-point increase, was independently and positively associated with adherence, while negative outcome expectancy, AOR = 0.95, 95% CI [0.93, 0.98], was negatively associated.
  
  
  CONCLUSIONS
  In light of the ongoing challenges associated with ART adherence among HIV-positive PWUD, and our findings of associations between adherence, self-efficacy, and outcomes expectancies, tailored intervention strategies based on constructs of social learning theory should be implemented and evaluated to improve adherence among HIV-infected PWUD.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: William K
authors.initials: WK
authors.lastname: Lee
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: M J S
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: Department of Educational Psychology and Leadership Studies, University of Victoria.
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D020377:Self Efficacy; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D013287:Illicit Drugs