TY - JOUR
T1 - Women of Reproductive Age Living with HIV in Argentina
T2 - Unique Challenges for Reengagement in Care
AU - Cecchini, Diego
AU - Alcaide, Maria Luisa
AU - Rodriguez, Violeta de Jesus
AU - Mandell, Lissa Nicole
AU - Abbamonte, John Michael
AU - Cassetti, Isabel
AU - Cahn, Pedro
AU - Sued, Omar
AU - Weiss, Stephen Marshall
AU - Jones, Deborah Lynne
N1 - This study evaluated nonadherence to prescribed ART among women of reproductive age in Argentina who were disengaged from HIV care and found that avoidance-based coping (not wanting to think about HIV) was the most frequent reason for not taking prescribed ART. Women utilizing avoidance-based coping had more depressive symptoms, lower motivation, and lower self-efficacy than those not using this maladaptive strategy. 15 As such, this constellation of factors (depression, motivation, and self-efficacy) appears to act as a driver of nonadherence to ART and likely contribute to disengagement from HIV care, poor HIV outcomes, and sexual and vertical transmission of HIV. 27 Results from this study complement the understanding of previous research on the contribution of depression to poor HIV and health outcomes for women of reproductive age living with HIV and for infants of mothers living with HIV worldwide. – 28 30 This study is however unique as it the first to utilize cluster analysis to clearly define that avoidance, low self-efficacy, and low motivation are critical drivers likely influenced by depression among women. The use of this novel statistical analysis allows to better understand the impact of exposure to multiple risks, so interventions can be targeted to subgroups that will benefit most, such as in this case, women with avoidance-based coping. Interestingly, our results using this approach indicate that when there is avoidance-based coping, depressive symptomatology negatively impacts ART uptake, even when depressive symptoms are low. However, isolation of the differences between those engaging or not engaging in avoidance-based coping clearly differentiated factors associated with the strategy of avoidance. Avoidance, while enabling the individual time to process a stressor, becomes a liability when it prevents resolution of the problem. Results highlight the importance of the integration of routine assessment and treatment of depression in HIV care 32 before the patient comes to rely on avoidance as a coping strategy. Therefore, targeting avoidance-based coping, likely with acceptance- and commitment-based therapies, may help promote reengagement in care and may, in turn, help prevent the sexual and perinatal transmission of HIV in this group of women. 31 , 32 Further research is needed to explore the mechanism behind avoidance-based coping and depression, and how these factors together may impact motivation and self-efficacy, which have been shown to be important for adherence and reengagement in care. 17 Interventions to improve HIV health outcomes among women living with HIV in Argentina and other regions have primarily focused on provision of ART in clinical settings and have neglected comprehensive reproductive and mental health treatment. Women represent over 50% of the population living with HIV worldwide and face unique challenges and barriers to HIV care. 33 Clearly, strategies for improving retention in care and ART adherence are essential to achieve the goal of controlling the HIV epidemic, and there is a need to understand barriers to care among the vulnerable population of women of reproductive age. 33 Despite the importance of our findings and the need to address depressive symptoms in this population, this study had several limitations. The primary limitation was the small sample size and the use of a cross-sectional analysis. In addition, the study relied on self-report, and though using a valid and reliable measure of depressive symptoms (the BDI), a depression diagnostic tool was not used. Additionally, some information related to HIV history (number of times they did not see a physician for more than 12 months and number of times they stopped taking ART for more than 3 months) was sometimes unavailable in the medical record and in those cases was self-reported, which may be subject to recall bias. This study highlights the importance of integrating mental health care into HIV care for women facing difficulties in coping with HIV, with the aim of increasing motivation and self-efficacy and reducing depression, to optimize the benefits of ART. As women living with HIV experience a disproportionate burden of poor health outcomes and mental illness, gender-specific interventions focused on the treatment of depression could be the gateway to improving HIV outcomes and preventing HIV transmission. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a grant from NIH, R01MH110242, and with the support of the University of Miami Miller School of Medicine Center for AIDS Research, funded by an NIH grant, P30AI073961. V.J.R.’s work on this study was partially supported by a Ford Foundation Fellowship, administered by the National Academies of Science. ORCID iD Maria L. Alcaide https://orcid.org/0000-0003-4648-0145
PY - 2019
Y1 - 2019
N2 - This study evaluated the reasons for not taking antiretroviral treatment (ART) among women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups and physician visits), with the goal of identifying strategies for reengagement in HIV care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who completed sociodemographic, medical history, reasons why they were not taking ART, mental health, motivation, and self-efficacy assessments. Latent class analysis was used for analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher depression (U = 608.5, z = −2.7, P =.007), lower motivation (U = 601, z = −2.8, P =.006), and lower self-efficacy (U = 644.5, z = −2.4, P =.017) than those not using this maladaptive strategy. As women living with HIV experience a disproportionate burden of poor health outcomes, interventions focused on the management of depression may improve HIV outcomes and prevent HIV transmission.
AB - This study evaluated the reasons for not taking antiretroviral treatment (ART) among women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups and physician visits), with the goal of identifying strategies for reengagement in HIV care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who completed sociodemographic, medical history, reasons why they were not taking ART, mental health, motivation, and self-efficacy assessments. Latent class analysis was used for analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher depression (U = 608.5, z = −2.7, P =.007), lower motivation (U = 601, z = −2.8, P =.006), and lower self-efficacy (U = 644.5, z = −2.4, P =.017) than those not using this maladaptive strategy. As women living with HIV experience a disproportionate burden of poor health outcomes, interventions focused on the management of depression may improve HIV outcomes and prevent HIV transmission.
KW - HIV
KW - South America
KW - women
UR - https://www.scopus.com/pages/publications/85073602523
UR - https://www.scopus.com/pages/publications/85073602523#tab=citedBy
U2 - 10.1177/2325958219883250
DO - 10.1177/2325958219883250
M3 - Article
C2 - 31623511
AN - SCOPUS:85073602523
SN - 2325-9574
VL - 18
JO - Journal of the International Association of Providers of AIDS Care
JF - Journal of the International Association of Providers of AIDS Care
ER -