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. 2019 Aug;23(8):2037-2047.
doi: 10.1007/s10461-018-2355-3.

Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV

Lauren M Hill  1   2 , Carol E Golin  3   4   5 , Nisha C Gottfredson  3 , Brian W Pence  6 , Bethany DiPrete  6 , Jessica Carda-Auten  3 , Jennifer S Groves  4 , Sonia Napravnik  5   6 , David Wohl  5 , Kevin Knight  7 , Patrick M Flynn  7
Affiliations

Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV

Lauren M Hill et al. AIDS Behav. 2019 Aug.

Abstract

Depression is a known risk factor for antiretroviral therapy (ART) non-adherence, but little is known about the mechanisms explaining this relationship. Identifying these mechanisms among people living with HIV (PLHIV) after release from prison is particularly important, as individuals during this critical period are at high risk for both depression and poor ART adherence. 347 PLHIV recently released from prison in North Carolina and Texas were included in analyses to assess mediation of the relationship between depressive symptoms at 2 weeks post-release and ART adherence (assessed by unannounced telephone pill counts) at weeks 9-21 post-release by the hypothesized explanatory mechanisms of alcohol use, drug use, adherence self-efficacy, and adherence motivation (measured at weeks 6 and 14 post-release). Indirect effects were estimated using structural equation models with maximum likelihood estimation and bootstrapped confidence intervals. On average, participants achieved 79% ART adherence. The indirect effect of depression on adherence through drug use was statistically significant; greater symptoms of depression were associated with greater drug use, which was in turn associated with lower adherence. Lower adherence self-efficacy was associated with depressive symptoms, but not with adherence. Depression screening and targeted mental health and substance use services for depressed individuals at risk of substance use constitute important steps to promote adherence to ART after prison release.

Keywords: Adherence; Antiretroviral therapy; Depression; Drug use; Incarceration; Mediation.

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Conflict of interest statement

Conflict of interest:

The authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Path diagram of mediation hypotheses
Figure 2.
Figure 2.
Adjusted coefficient esimates for path, direct, and total effects *statistically significant (non-zero 95% confidence interval – see Table 2)
Figure 3.
Figure 3.
Sensitivity analysis: Estimated indirect effect and confidence interval by values of ρ
See this image and copyright information in PMC

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