title: Social Support and the Mediating Roles of Alcohol Use and Adherence Self-Efficacy on Antiretroviral Therapy (ART) Adherence Among ART Recipients in Gauteng, South Africa.
abstract: We sought to (a) replicate and (b) extend (via the addition of alcohol use) Cha et al.'s cross-sectional multi-component model of ART adherence on the relationship between social support, depression, self-efficacy beliefs, and antiretroviral therapy (ART) adherence, among HIV patients in Tshwane, South Africa. Using purposive sampling, 304 male and female ART recipients were recruited. ART adherence was assessed using three manifest indicators: total adherence ratio, the CASE adherence index and 1-month adherence measure. Data were analysed using structural equation modeling. In our replicated model, social support had both direct and indirect relationships with ART adherence, and inclusion of alcohol use improved prediction of ART adherence. Direct and indirect effects of alcohol use on ART adherence emerged: adherence self-efficacy beliefs partially mediated the latter path. Findings highlight the importance of integrating into ART promotion interventions, the reduction of alcohol use, provision of social support, and enhancement of adherence self-efficacy beliefs.
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Private Bag X385, Pretoria, South Africa. connie.kekwaletswe@mrc.ac.za.
authors.forename: Connie T
authors.initials: CT
authors.lastname: Kekwaletswe
authors.affiliation: Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Esmé
authors.initials: E
authors.lastname: Jordaan
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Private Bag X385, Pretoria, South Africa.
authors.forename: Sebenzile
authors.initials: S
authors.lastname: Nkosi
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Private Bag X385, Pretoria, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neo K
authors.initials: NK
authors.lastname: Morojele
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D020377:Self Efficacy; D012944:Social Support; D013019:South Africa; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Alcohol use; Antiretroviral therapy; Social support; South Africa