This article was downloaded by: [North Dakota State University] On: 02 November 2014, At: 08:57 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons Kartavya J. Vyas a
abc
a
a
, Joanne Limneos , Huifang Qin & William C. Mathews
ad
Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
b
Department of Deployment Health Research, Naval Health Research Center, San Diego, CA, USA c
Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK d
Department of Medicine, University of California San Diego, La Jolla, CA, USA Published online: 06 Feb 2014.
To cite this article: Kartavya J. Vyas, Joanne Limneos, Huifang Qin & William C. Mathews (2014) Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 26:8, 983-987, DOI: 10.1080/09540121.2014.882486 To link to this article: http://dx.doi.org/10.1080/09540121.2014.882486
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2014 Vol. 26, No. 8, 983–987, http://dx.doi.org/10.1080/09540121.2014.882486
Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons Kartavya J. Vyasa,b,c*, Joanne Limneosa, Huifang Qina and William C. Mathewsa,d a
Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA; bDepartment of Deployment Health Research, Naval Health Research Center, San Diego, CA, USA; cInfectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; dDepartment of Medicine, University of California San Diego, La Jolla, CA, USA
Downloaded by [North Dakota State University] at 08:57 02 November 2014
(Received 5 May 2013; accepted 7 January 2014) The efficacy of highly active antiretroviral therapy (HAART) is dependent upon moderately high levels of adherence; however, predicting adherence before HAART initiation can be difficult. We conducted a prospective, longitudinal study among 350 HIV-infected adults attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011 to examine both established and novel predictors of adherence, including religious practices and beliefs. Statistically significant (p < .05) variables identified in bivariate analyses were included in multivariate analyses predicting ≥90% adherence. Higher annual household income (p = .004) and religious affiliation (p = .031) were predictive of greater adherence. Participants who said their beliefs gave meaning to their lives, made them feel they had a connection with a higher being, were influential during their recovery, and helped them feel connected to humanity were more likely to be ≥90% adherent (p < .015). Conversely, participants who believed God created all things in the universe; that God will not turn his back on them; and those who regularly attended religious services, participated in religious rituals, and prayed and meditated to get in touch with God were less likely to be ≥90% adherent (p ≤ .025). Results indicate that a patient’s religious beliefs and practices may predict medication adherence. Interventions should be designed to emphasize the use of positive religious coping strategies and address the adverse implications of religious fatalism. Keywords: adherence; antiretroviral medications; HAART; HIV; religion
Introduction
Materials and methods
In the era of highly active antiretroviral therapy (HAART), the advent of newer, more potent regimens has dramatically improved clinical outcomes as well as increased the overall quality of life for HIV-infected individuals (Karon, Fleming, Steketee, & De Cock, 2001; Murphy et al., 2001). However, there are many factors that influence the success of treatment, including disease stage, medication adherence, and the presence of resistant strains of HIV (Chesney, Morin, & Sherr, 2000a; Flannelly & Inouye, 2001). Of the influences listed, medication adherence may be the most pivotal, but also the most difficult, item a physician must consider before initiating a patient on HAART (Chesney, Ickovics, & Chambers, 2000b; Van Vaerenbergh et al., 2002). Avoided as a legitimate inquiry of scientific study in the past has been the association of religious practices and beliefs on adherence (Wallis, 1996). In this longitudinal study we attempted to identify the most clinically meaningful predictors of adherence from among those assessed at baseline, including religious beliefs and practices.
Participants and procedures
*Corresponding author. Email: [email protected] © 2014 Taylor & Francis
We conducted a prospective, longitudinal study among HIV-positive patients attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011. Participants provided written, informed consent, and were followed over a six-month period. The study was approved by the University of California, San Diego Institutional Review Board.
Measures Outcome measure The simplified Adult AIDS Clinical Trial Group (ACTG) adherence questionnaire, composed of five items, measures self-reported adherence to antiretrovirals (Chesney et al., 2000b; Mathews et al., 2002, 2008). At each clinic visit during the follow-up period, we captured the patients’ responses to these five items and then calculated summary adherence scores at three and six months after baseline. Using data from a previous study (Mathews et al., 2002), we were able to demonstrate that a
984
K.J. Vyas et al.
self-reported adherence score of ≤1 by the ACTG questionnaire correlated with ≥90% adherence by Medication Event Monitoring System (MEMS), a more direct measure of adherence (data not shown).
Downloaded by [North Dakota State University] at 08:57 02 November 2014
Baseline measures Baseline sociodemographics included: age, sex, race, educational attainment, annual household income, religious affiliation, and relationship status. Clinically relevant baseline measures captured from medical records included: HIV viral load, CD4 cell count, Centers for Disease Control and Prevention (CDC) stage, and the following self-reported variables: health state, substance abuse, and anxiety or depression. The complexity of the patient’s medication regimen was assessed at baseline using criteria defined by Mathews et al. (2002). Religious beliefs and practices of patients were assessed on a five-point Likert scale at baseline using the 25-item Ironson-Woods Spirituality/Religiousness (SR) Index (Cronbach’s α = 0.96), developed and validated by Ironson et al. (2002) to describe the beliefs and affective, behavioral, and somatic realms of patients facing life-threatening illnesses, particularly HIV/AIDS. Statistical analysis Univariate analyses were performed on all potential predictor variables. Bivariate analyses assessed associations between baseline variables and ≥90% adherence at three and six months. All statistically significant variables (p < .05) were considered for inclusion in a multivariate model to determine those independently associated with ≥90% adherence. Generalized estimating equations models with repeated measures were used. Analyses were performed using SPSS version 17.0 (SPSS Inc., Chicago, IL). Results Participant characteristics A total of 350 randomly selected HIV-infected patients participated in the study. As shown in Table 1, the mean age of participants was 45.9 years (SD = 9.7 years) and the majority were male (92%), Caucasian (56%), and married/committed (61%). Of note, 60% identified themselves as Christian and 24% as having no religious affiliation. Almost half were classified as CDC stage C (46%) and 10% were ART naïve at baseline. Multivariate analyses of baseline predictors As shown in the final multivariate model (Table 2), 14 factors were independently associated with ≥90% adherence, including: greater annual household income (≥$10,000; adjusted odds ratio [AOR] 2.37 [1.10–5.14], p = .004), being affiliated with a religious institution
Table 1. Baseline characteristics of study participants (n = 350 HIV-infected patients). n Age, years Sex Male Female Race Caucasian Hispanic African-American Asian Native American > 1 race/other Educational attainment Some high school education High school graduate Some college education or trade school College graduate Annual household income (USD) < 5000 5000–10,000 10,001–20,000 > 20,000 Religious affiliation Christian Buddhist Muslim Jewish Other None Relationship status Single Married/committed Divorced/separated/widowed Other HIV clinical indicators CDC stage C CD4 count
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons Kartavya J. Vyas a
abc
a
a
, Joanne Limneos , Huifang Qin & William C. Mathews
ad
Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA
b
Department of Deployment Health Research, Naval Health Research Center, San Diego, CA, USA c
Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK d
Department of Medicine, University of California San Diego, La Jolla, CA, USA Published online: 06 Feb 2014.
To cite this article: Kartavya J. Vyas, Joanne Limneos, Huifang Qin & William C. Mathews (2014) Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 26:8, 983-987, DOI: 10.1080/09540121.2014.882486 To link to this article: http://dx.doi.org/10.1080/09540121.2014.882486
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
AIDS Care, 2014 Vol. 26, No. 8, 983–987, http://dx.doi.org/10.1080/09540121.2014.882486
Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons Kartavya J. Vyasa,b,c*, Joanne Limneosa, Huifang Qina and William C. Mathewsa,d a
Owen Clinic, University of California San Diego Medical Center, San Diego, CA, USA; bDepartment of Deployment Health Research, Naval Health Research Center, San Diego, CA, USA; cInfectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; dDepartment of Medicine, University of California San Diego, La Jolla, CA, USA
Downloaded by [North Dakota State University] at 08:57 02 November 2014
(Received 5 May 2013; accepted 7 January 2014) The efficacy of highly active antiretroviral therapy (HAART) is dependent upon moderately high levels of adherence; however, predicting adherence before HAART initiation can be difficult. We conducted a prospective, longitudinal study among 350 HIV-infected adults attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011 to examine both established and novel predictors of adherence, including religious practices and beliefs. Statistically significant (p < .05) variables identified in bivariate analyses were included in multivariate analyses predicting ≥90% adherence. Higher annual household income (p = .004) and religious affiliation (p = .031) were predictive of greater adherence. Participants who said their beliefs gave meaning to their lives, made them feel they had a connection with a higher being, were influential during their recovery, and helped them feel connected to humanity were more likely to be ≥90% adherent (p < .015). Conversely, participants who believed God created all things in the universe; that God will not turn his back on them; and those who regularly attended religious services, participated in religious rituals, and prayed and meditated to get in touch with God were less likely to be ≥90% adherent (p ≤ .025). Results indicate that a patient’s religious beliefs and practices may predict medication adherence. Interventions should be designed to emphasize the use of positive religious coping strategies and address the adverse implications of religious fatalism. Keywords: adherence; antiretroviral medications; HAART; HIV; religion
Introduction
Materials and methods
In the era of highly active antiretroviral therapy (HAART), the advent of newer, more potent regimens has dramatically improved clinical outcomes as well as increased the overall quality of life for HIV-infected individuals (Karon, Fleming, Steketee, & De Cock, 2001; Murphy et al., 2001). However, there are many factors that influence the success of treatment, including disease stage, medication adherence, and the presence of resistant strains of HIV (Chesney, Morin, & Sherr, 2000a; Flannelly & Inouye, 2001). Of the influences listed, medication adherence may be the most pivotal, but also the most difficult, item a physician must consider before initiating a patient on HAART (Chesney, Ickovics, & Chambers, 2000b; Van Vaerenbergh et al., 2002). Avoided as a legitimate inquiry of scientific study in the past has been the association of religious practices and beliefs on adherence (Wallis, 1996). In this longitudinal study we attempted to identify the most clinically meaningful predictors of adherence from among those assessed at baseline, including religious beliefs and practices.
Participants and procedures
*Corresponding author. Email: [email protected] © 2014 Taylor & Francis
We conducted a prospective, longitudinal study among HIV-positive patients attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011. Participants provided written, informed consent, and were followed over a six-month period. The study was approved by the University of California, San Diego Institutional Review Board.
Measures Outcome measure The simplified Adult AIDS Clinical Trial Group (ACTG) adherence questionnaire, composed of five items, measures self-reported adherence to antiretrovirals (Chesney et al., 2000b; Mathews et al., 2002, 2008). At each clinic visit during the follow-up period, we captured the patients’ responses to these five items and then calculated summary adherence scores at three and six months after baseline. Using data from a previous study (Mathews et al., 2002), we were able to demonstrate that a
984
K.J. Vyas et al.
self-reported adherence score of ≤1 by the ACTG questionnaire correlated with ≥90% adherence by Medication Event Monitoring System (MEMS), a more direct measure of adherence (data not shown).
Downloaded by [North Dakota State University] at 08:57 02 November 2014
Baseline measures Baseline sociodemographics included: age, sex, race, educational attainment, annual household income, religious affiliation, and relationship status. Clinically relevant baseline measures captured from medical records included: HIV viral load, CD4 cell count, Centers for Disease Control and Prevention (CDC) stage, and the following self-reported variables: health state, substance abuse, and anxiety or depression. The complexity of the patient’s medication regimen was assessed at baseline using criteria defined by Mathews et al. (2002). Religious beliefs and practices of patients were assessed on a five-point Likert scale at baseline using the 25-item Ironson-Woods Spirituality/Religiousness (SR) Index (Cronbach’s α = 0.96), developed and validated by Ironson et al. (2002) to describe the beliefs and affective, behavioral, and somatic realms of patients facing life-threatening illnesses, particularly HIV/AIDS. Statistical analysis Univariate analyses were performed on all potential predictor variables. Bivariate analyses assessed associations between baseline variables and ≥90% adherence at three and six months. All statistically significant variables (p < .05) were considered for inclusion in a multivariate model to determine those independently associated with ≥90% adherence. Generalized estimating equations models with repeated measures were used. Analyses were performed using SPSS version 17.0 (SPSS Inc., Chicago, IL). Results Participant characteristics A total of 350 randomly selected HIV-infected patients participated in the study. As shown in Table 1, the mean age of participants was 45.9 years (SD = 9.7 years) and the majority were male (92%), Caucasian (56%), and married/committed (61%). Of note, 60% identified themselves as Christian and 24% as having no religious affiliation. Almost half were classified as CDC stage C (46%) and 10% were ART naïve at baseline. Multivariate analyses of baseline predictors As shown in the final multivariate model (Table 2), 14 factors were independently associated with ≥90% adherence, including: greater annual household income (≥$10,000; adjusted odds ratio [AOR] 2.37 [1.10–5.14], p = .004), being affiliated with a religious institution
Table 1. Baseline characteristics of study participants (n = 350 HIV-infected patients). n Age, years Sex Male Female Race Caucasian Hispanic African-American Asian Native American > 1 race/other Educational attainment Some high school education High school graduate Some college education or trade school College graduate Annual household income (USD) < 5000 5000–10,000 10,001–20,000 > 20,000 Religious affiliation Christian Buddhist Muslim Jewish Other None Relationship status Single Married/committed Divorced/separated/widowed Other HIV clinical indicators CDC stage C CD4 count
