Association between HIV stigma and antiretroviral therapy adherence among adults living with HIV: baseline findings from the HPTN 071 (PopART) trial in Zambia and South Africa

Harriet S Jones, Sian Floyd, Anne Stangl, Virginia Bond, Graeme Hoddinott, Triantafyllos Pliakas, Justin Bwalya, Nomtha Mandla, Ayana Moore, Deborah Donnell, Peter Bock, Sarah Fidler, Richard Hayes, Helen Ayles, James R Hargreaves, HPTN 071 (PopART) Study Team, Harriet S Jones, Sian Floyd, Anne Stangl, Virginia Bond, Graeme Hoddinott, Triantafyllos Pliakas, Justin Bwalya, Nomtha Mandla, Ayana Moore, Deborah Donnell, Peter Bock, Sarah Fidler, Richard Hayes, Helen Ayles, James R Hargreaves, HPTN 071 (PopART) Study Team

Abstract

Objectives: Adherence to antiretroviral therapy (ART) leads to viral suppression for people living with HIV (PLHIV) and is critical for both individual health and reducing onward HIV transmission. HIV stigma is a risk factor that can undermine adherence. We explored the association between HIV stigma and self-reported ART adherence among PLHIV in 21 communities in the HPTN 071 (PopART) trial in Zambia and the Western Cape of South Africa.

Methods: We conducted a cross-sectional analysis of baseline data collected between 2013 and 2015, before the roll-out of trial interventions. Questionnaires were conducted, and consenting participants provided a blood sample for HIV testing. Poor adherence was defined as self-report of not currently taking ART, missing pills over the previous 7 days or stopping treatment in the previous 12 months. Stigma was categorised into three domains: community, health setting and internalised stigma. Multivariable logistic regression was used for analysis.

Results: Among 2020 PLHIV self-reporting ever taking ART, 1888 (93%) were included in multivariable analysis. Poor ART adherence was reported by 15.8% (n = 320) of participants, and 25.7% (n = 519) reported experiencing community stigma, 21.5% (n = 434) internalised stigma, and 5.7% (n = 152) health setting stigma. PLHIV who self-reported previous experiences of community and internalised stigma more commonly reported poor ART adherence than those who did not (aOR 1.63, 95% CI 1.21 -2.19, P = 0.001 and aOR 1.31, 95% CI 0.96-1.79, P = 0.09).

Conclusions: HIV stigma was associated with poor ART adherence. Roll-out of universal treatment will see an increasingly high proportion of PLHIV initiated on ART. Addressing HIV stigma could make an important contribution to supporting lifelong ART adherence.

Trial registration: ClinicalTrials.gov NCT01900977.

Keywords: Afrique du Sud; South Africa; Zambia; Zambie; adhésion au traitement; antiretroviral therapy; human immunodeficiency virus; stigma; stigmatisation; thérapie antirétrovirale; treatment adherence; virus de l'immunodéficience humaine.

© 2020 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Conceptual framework.
Figure 2
Figure 2
Study population

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Source: PubMed

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