title: Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the Netherlands: Results from the ROtterdam ADherence (ROAD) Project.
abstract: In the Netherlands, immigrant people living with HIV (PLWH) have poorer psychological and treatment outcomes than Dutch PLWH. This cross-sectional field study examined risk factors for non-adherence to combination Antiretroviral Therapy (cART) among immigrant PLWH. First and second generation immigrant PLWH attending outpatient clinics at two HIV-treatment centers in Rotterdam were selected for this study. Socio-demographic and clinical characteristics for all eligible participants were collected from an existing database. Trained interviewers subsequently completed questionnaires together with consenting participants (n = 352) to gather additional data on socio-demographic characteristics, psychosocial variables, and self-reported adherence to cART. Univariable and multivariable logistic regression analyses were conducted among 301 participants who had used cART ≥6 months prior to inclusion. Independent risk factors for self-reported non-adherence were (I) not having attended formal education or only primary school (OR = 3.25; 95% CI: 1.28-8.26, versus University), (II) experiencing low levels of social support (OR = 2.56; 95% CI: 1.37-4.82), and (III) reporting low treatment adherence self-efficacy (OR = 2.99; 95% CI: 1.59-5.64). Additionally, HIV-RNA >50 copies/ml and internalized HIV-related stigma were marginally associated (P<0.10) with non-adherence (OR = 2.53; 95% CI: 0.91-7.06 and OR = 1.82; 95% CI: 0.97-3.43). The findings that low educational attainment, lack of social support, and low treatment adherence self-efficacy are associated with non-adherence point to the need for tailored supportive interventions. Establishing contact with peer immigrant PLWH who serve as role models might be a successful intervention for this specific population.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Sabrina K
authors.initials: SK
authors.lastname: Been
authors.affiliation: Department of Virology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: David A M C
authors.initials: DA
authors.lastname: van de Vijver
authors.affiliation: Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Pythia T
authors.initials: PT
authors.lastname: Nieuwkerk
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Inês
authors.initials: I
authors.lastname: Brito
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Stutterheim
authors.affiliation: Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
authors.forename: Arjan E R
authors.initials: AE
authors.lastname: Bos
authors.affiliation: Municipal Public Health Service Rotterdam-Rijnmond, Infectious Disease Control Division, Rotterdam, The Netherlands.
authors.forename: Mireille E G
authors.initials: ME
authors.lastname: Wolfers
authors.affiliation: Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Katalin
authors.initials: K
authors.lastname: Pogány
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Verbon
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D020377:Self Efficacy; D057566:Self Report; D012944:Social Support; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral