Relationship of Economic and Psychosocial Factors on Adherence to HAART: Findings from a study of PLWH attending public clinics in Rio de Janeiro, Brazil

The purpose of this study was to examine the relationship of economic and psychosocial factors on HAART adherence for PLWH attending public clinics in Rio de Janeiro. There are assumptions that populations of resource-limited countries have more barriers to adherence, therefore increasing the emergence of viral resistance with increasing access to ARVs. In a country such as Brazil where there is universal access to ARVs, it is important to understand how people accessing care through public clinics can have good adherence. A cross-sectional survey design was conducted using the ACTG questionnaire with 650 participants currently on HAART recruited from 6 public health clinics. The clinics were selected based on caseload and location. Multivariate logistic regression analyses was used to assess the associations with HAART adherence. Approximately 84% of respondents reported adherence to all of their doses in the last 4 days. Having a high asset index made one 2.47 times more adherent than a low index. Those with high social support were 2.85 times more adherent than those with low social support. Anxiety (OR .65) was negatively associated with adherence when controlling for socio-demographic variables but the addition of social support controlled for the effects of anxiety. Women (OR .58) were consistently less adherent than men across all models. This research highlights the importance of examining the social context and economic vulnerabilities to improve HAART adherence. Social support played a key role in good adherence. Future research needs to look into the different gender dynamics of adherence.