Correlates of poor anti-retroviral (ARV) adherence among a sample of HIV+ adults in Haiti: Implications for intervention

Background: Haiti has the highest number of HIV-infected persons in the Caribbean region. Behavioral interventions to promote adherence to ARV treatment are considered critical to improving outcomes of HIV/AIDS programs. In this study we determine the factors associated with non-adherence to ARV medication among a sample of males and females (N= 257, ♂=98, ♀=159; mean age= 35.39 ± 8.44 years) enrolled in an ongoing NIH/NIAAA funded study designed to simultaneously enhance safer sex practices, adherence to ARV medication, and reduce the use of alcohol or other drugs. Methods: Baseline data on medication adherence as well as background characteristics and mental health were analyzed using independent sample t-tests, chi square and Pearson correlation. Measures included self-reported adherence using the modified Access & Utilization of Care (AUC) instrument, the Beliefs about Medicines Questionnaire (BMQ), the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies Depression scale (CES-D). Results: The majority of the participants (75%) were prescribed ARVs, and 83% reported 100% adherence. Significant correlates of non-adherence were female gender (χ2 (1) =5.414, p=.02), state anxiety (r=0.148. p=0.041), trait anxiety (r=0.146, p=0.043), and worry about taking ARV medication (r=-0.166, p=0.021). Females also reported significantly higher mean depression (t=-3.98, p=0.0001) and trait anxiety scores (t=-2.63, p=0.009) than males. Conclusions: This study found significant associations between gender, anxiety, depression, worry about ARVs, and reported non-adherence among our sample of HIV-infected adults in Haiti. The results suggest that interventions with this population should specifically address women's mental health concerns.