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Substance Use Predictors of Poor Medication Adherence: The Role of Substance Use Coping Among HIV-Infected Patients in Opioid Dependence Treatment

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Abstract

Many HIV-infected injection drug users (IDUs) continue to use illicit substances despite being in substance use treatment. Substance use is associated with non-adherence to HIV medications; however underlying mechanisms regarding this relation are understudied. The current investigation examined the role of substance use coping in terms of the relation between substance use and HIV medication adherence. Participants were 121 HIV-infected IDUs (41 % female, M age = 47, SD = 7.1) in opioid dependence treatment. Participants completed self-report questionnaires, were administered clinical interviews and oral toxicology screens, and used a medication-event-monitoring-system cap to assess 2 week HIV medication adherence. The use of cocaine and multiple substances were significantly related to decreased medication adherence. Substance use coping mediated these associations. Findings highlight the importance of assessing, monitoring, and targeting ongoing substance use, and ways to increase positive coping for HIV-infected IDUs in substance use treatment to aid in HIV medication adherence.

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References

  1. de Olalla PG, Knobel H, Carmona A, Guelar A, Lopez-Colomes JL, Cayla JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;30:105–10.

    Google Scholar 

  2. Low-Beer S, Yip B, O’Shaughnessy MV, et al. Adherence to triple therapy and viral load response. J Acquir Immune Defic Syndr. 2000;23:360–1.

    PubMed  CAS  Google Scholar 

  3. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133:21–30.

    PubMed  CAS  Google Scholar 

  4. Thompson MA, Aberg JA, Cahn P, et al. Antiretroviral treatment of adult HIV infection. J Am Med Assoc. 2010;304:321–33.

    Article  CAS  Google Scholar 

  5. Kuritzkes DR. HIV drug resistance: new insight and updated practices. Physicians’ Res Netw. 2004;9:9–13.

    Google Scholar 

  6. Gardner EM, Sharma S, Peng G, et al. Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS. 2008;22:75–82.

    Article  PubMed  CAS  Google Scholar 

  7. Castilla J, del Romero J, Hernando V, et al. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr. 2005;40:96–101.

    Article  PubMed  Google Scholar 

  8. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.

    Article  PubMed  CAS  Google Scholar 

  9. Quinn TC, Wawer MJ, Sewnkanbo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type-1. N Engl J Med. 2000;342:921–9.

    Article  PubMed  CAS  Google Scholar 

  10. Porco TC, Martin JN, Page-Shafer KA, et al. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS. 2004;18:81–8.

    Article  PubMed  Google Scholar 

  11. Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medication treatment. Curr HIV/AIDS Rep. 2011;8:223–34.

    Article  PubMed  Google Scholar 

  12. Spire B, Lucas GM, Carrier MP. Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST). Int J Drug Policy. 2007;18:262–70.

    Article  PubMed  Google Scholar 

  13. Glass TR, Battegay M, Cavassini M, et al. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: swiss HIV cohort study. J Acquir Immune Defic Syndr. 2010;54:197–203.

    PubMed  Google Scholar 

  14. Stein MD, Rich JD, Maksad J, et al. Adherence to antiretroviral therapy among HIV-infected methadone patients: effect of ongoing illicit drug use. Am J Drug Alcohol Abuse. 2000;26:195–205.

    Article  PubMed  CAS  Google Scholar 

  15. Weber R, Huber M, Rickenbach M, et al. Uptake of and virological response to antiretroviral therapy among HIV-infect former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study. HIV Med. 2009;10:407–16.

    Article  PubMed  CAS  Google Scholar 

  16. Cohn SE, Jiang H, McCutchan JA, et al. Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362. AIDS Care. 2011;23:775–85.

    Article  PubMed  Google Scholar 

  17. Hinkin CH, Barclay TR, Castellon SA, et al. Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav. 2007;11:185–94.

    Article  PubMed  Google Scholar 

  18. Abrams DB, Niaura RS. Social learning theory of alcohol use and abuse. In: Blane H, Leonard K, editors. Psychological theories of drinking and alcoholism. New York: Guilford Press; 1987. p. 131–78.

    Google Scholar 

  19. Shiffman S, Wills TA. Coping and cessation of substance use. In: Shiffman S, Wills TA, editors. Coping and substance use. New York: Academic Press; 1985. p. 221–40.

    Google Scholar 

  20. Gonzalez JS, Batchelder AW, Psaros C, Safren S. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58:181–7.

    PubMed  Google Scholar 

  21. Waldrop-Valverde D, Valverde E. Homelessness and psychological distress as contributors to antiretroviral adherence in HIV-positive injection drug users. AIDS Patient Care STDs. 2004;19:226–334.

    Google Scholar 

  22. Power R, Koopman C, Volk J, et al. Social support, substance use, and denial in relationship to antiretroviral treatment adherence among HIV-infected patients. AIDS Patient Care STDs. 2003;17:245–52.

    Article  PubMed  Google Scholar 

  23. Liu H, Golin CE, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134:968–77.

    PubMed  CAS  Google Scholar 

  24. Liu H, Miller G, Hays RD, et al. Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors. J Acquir Immune Defic Syndr. 2006;41:315–22.

    Article  PubMed  Google Scholar 

  25. Llabre MM, Weaver KE, Duran RE, Antoni MH, McPherson-Baker S, Schneiderman N. A measurement model of medication adherence to highly active antiretroviral therapy and its relation to viral load in HIV-positive adults. AIDS Patient Care STDs. 2006;20:701–11.

    Article  PubMed  Google Scholar 

  26. Safren SA, O’Cleirigh CO, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28:1–10.

    Article  PubMed  Google Scholar 

  27. Safren SA, O’Cleirigh CM, Bullis JR, Otto MS, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80:404–15.

    Article  PubMed  Google Scholar 

  28. Stirratt MJ, Remien RH, Smith A, et al. The role of HIV serostatus disclosure in antiretroviral medications adherence. AIDS Behav. 2006;10:483–93.

    Article  PubMed  Google Scholar 

  29. Carver CS. You want to measure coping but your protocol is too long: consider the Brief COPE. Int J Behav Med. 1997;4:92–100.

    Article  PubMed  CAS  Google Scholar 

  30. Bottonari KA, Safren SA, McQuaid JR, Hsiao C, Roberts JE. A longitudinal investigation of the impact of life stress on HIV treatment adherence. J Behav Med. 2010;33:486–95.

    Article  PubMed  Google Scholar 

  31. Kelly BC, Bimbi DS, Izienicki H, Parsons JT. Stress and coping among HIV-positive barebackers. AIDS Behav. 2009;13:792–7.

    Article  PubMed  Google Scholar 

  32. Gay C, Portillo CJ, Kelly R, et al. Self-reported medication adherence and symptom experience in adults with HIV. J Assoc Nurses AIDS Care. 2011;22:257–68.

    Article  PubMed  Google Scholar 

  33. Hinkin CH, Hardy DJ, Mason KL, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25.

    Article  PubMed  Google Scholar 

  34. Puskas CM, Forrest JI, Parashar S, et al. Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8:277–87.

    Article  PubMed  Google Scholar 

  35. Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med. 2003;18:248–57.

    Article  PubMed  Google Scholar 

  36. Baron R, Kenny D. The moderator-mediator distinction in social psychological research: conceptual strategic and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.

    Article  PubMed  CAS  Google Scholar 

  37. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhardt S, editor. Sociological Methodology. Washington: American Sociological Association; 1982. p. 290–312.

    Google Scholar 

  38. Hessol NA, Weber KM, Holman S, et al. Retention and attendance of women enrolled in a large prospective study of HIV-1 in the United States. J Womens Health. 2009;18:1627–37.

    Article  Google Scholar 

  39. Gonzalez A, Vujanovic AA, Johnson KA, Leyro TM, Zvolensky MJ. The role of mindful attention in regard to the relation between negative affect reduction outcome expectancies and emotional vulnerability among adult daily smokers. Cogn Ther Res. 2009;33:645–56.

    Article  Google Scholar 

  40. Johnson KA, Zvolensky MJ, Marshall EC, Gonzalez A, Abrams K, Vujanovic AA. Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability. Addict Behav. 2008;33:1416–24.

    Article  PubMed  Google Scholar 

  41. Blashill AJ, Perry N, Safren SS. Mental health: a focus on stress, coping, and mental illness as it related to treatment retention, adherence, and other health outcomes. Curr HIV/AIDS Rep. 2011;8:215–22.

    Article  PubMed  Google Scholar 

  42. Stone AA, Shiffman S. Ecological momentary assessment (EMA) in behavioral medicine. Ann Behav Med. 1994;16:99–202.

    Google Scholar 

  43. Krusi A, Wood E, Montaner J, Kerr T. Social and structural determinants of HAART access and adherence among injection drug users. Int J Drug Policy. 2010;21:4–9.

    Article  PubMed  Google Scholar 

  44. Palepu A, Milloy M, Kerr T, Zhang R, Wood E. Homelessness and adherence to antiretroviral therapy among a cohort of HIV-infected drug users. J Urban Health. 2011;88:545–55.

    Article  PubMed  Google Scholar 

  45. Sharpe TT, Lee LM, Nakashima AK, et al. Crack cocaine use and antiretroviral treatment among HIV-infected Black women. J Community Health. 2004;29:117–27.

    Article  PubMed  Google Scholar 

  46. Baum M, Rafie C, Lai S, et al. Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. J Acquir Immune Defic Syndr. 2009;50:93–9.

    Article  PubMed  Google Scholar 

  47. Duncan R, Shapshak P, Page JB, et al. Crack cocaine: effect modifier of RNA viral load and CD4 count in HIV-infected African American women. Front Biosci. 2007;12:1488–95.

    Article  PubMed  CAS  Google Scholar 

  48. McLellan TA, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. J Nerv Ment Dis. 1980;168:26–33.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Funding for data collection for this project is from R-01 DA018603 (Safren). Some of the investigator time was supported by Grant K24 MH094214 (Safren).

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Adam Gonzalez, Matthew J. Mimiaga, C. Andres Bedoya & Steven A. Safren

  2. Department of Psychiatry and Behavioral Science, State University of New York, Putnam Hall-South Campus, Stony Brook, NY, 11794, USA

    Adam Gonzalez

  3. The Fenway Institute, Boston, MA, USA

    Matthew J. Mimiaga & Steven A. Safren

  4. Department of Psychology, University of Missouri, St. Louis, MO, USA

    Jared Israel

Authors
  1. Adam Gonzalez
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  2. Matthew J. Mimiaga
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  5. Steven A. Safren
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Correspondence to Adam Gonzalez.

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Gonzalez, A., Mimiaga, M.J., Israel, J. et al. Substance Use Predictors of Poor Medication Adherence: The Role of Substance Use Coping Among HIV-Infected Patients in Opioid Dependence Treatment. AIDS Behav 17, 168–173 (2013). https://doi.org/10.1007/s10461-012-0319-6

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  • DOI: https://doi.org/10.1007/s10461-012-0319-6

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