Socio-cognitive facilitators of ART-adherence among predominantly black sexual and gender minoritized persons living with HIV in Atlanta, Georgia: a latent profile analysis.

IF 2.8 3区 医学 Q2 PSYCHOLOGY, CLINICAL Journal of Behavioral Medicine Pub Date : 2024-12-01 Epub Date: 2024-08-31 DOI:10.1007/s10865-024-00510-5
John Mark Wiginton, Lisa A Eaton, Valeria A Earnshaw, Ryan J Watson, Seth C Kalichman
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Abstract

The Integrated Change Model describes several social and cognitive factors (e.g., health attitudes, social support, self-efficacy) that can affect medication adherence. Guided by this model, we sought to identify profiles of socio-cognitive facilitators of ART (antiretroviral therapy) adherence among diversely minoritized persons living with HIV enrolled in a behavioral intervention trial in Atlanta, Georgia (N = 477). To do this, we performed latent profile analysis on baseline responses to scales assessing 6 indicators of interest: HIV-care self-efficacy, social support, TasP (treatment-as-prevention) beliefs, trust in healthcare providers, perceived need for ART, and trust in ART. We regressed emergent profiles on internalized, enacted, and microaggressive HIV stigma and compared prospective 30-day ART adherence and several cross-sectional HIV outcomes across profiles. Mean age was 29 years; 83% of participants were non-Hispanic Black, 53% were gay/homosexual-identifying, and 12% were gender expansive. Three profiles emerged: "Constrained/Capable" (6%), featuring high self-efficacy but low-moderate provider trust, social support, TasP beliefs, ART trust, and ART need; "Conflicted" (13%), featuring high TasP beliefs, provider trust, and ART need but moderate self-efficacy, ART trust, and social support; and "Motivated" (81%), featuring high levels of all indicators. Greater internalized, enacted, and microaggressive stigma were positively associated with "Conflicted" relative to "Motivated" profile membership. ART-nonadherence, unsuppressed viral load, and viral load unawareness were more likely for the "Conflicted" relative to the "Motivated" profile. Personalized HIV care tailored to such profiles may improve ART adherence and related outcomes for minoritized persons living with HIV.

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佐治亚州亚特兰大以黑人为主的性与性别少数群体艾滋病病毒感染者坚持抗逆转录病毒疗法的社会认知促进因素:潜在特征分析。
综合改变模型描述了可能影响坚持用药的几个社会和认知因素(如健康态度、社会支持、自我效能)。在这一模型的指导下,我们试图在佐治亚州亚特兰大市参加行为干预试验的不同少数民族艾滋病病毒感染者(N = 477)中找出坚持抗逆转录病毒疗法(ART)的社会认知促进因素。为此,我们对评估 6 项相关指标的量表基线反应进行了潜在特征分析:HIV 护理自我效能、社会支持、TasP(治疗即预防)信念、对医疗服务提供者的信任、抗逆转录病毒疗法的感知需求以及对抗逆转录病毒疗法的信任。我们将新出现的特征与内化的、已形成的和微攻击性的 HIV 耻辱进行了回归,并比较了不同特征的前瞻性 30 天抗逆转录病毒疗法坚持率和几种横断面 HIV 结果。平均年龄为 29 岁;83% 的参与者为非西班牙裔黑人,53% 为同性恋/同性认同者,12% 为性别扩张者。形成了三种特征:"受限/有能力"(6%),自我效能感高,但提供者信任度、社会支持、TasP 信仰、抗逆转录病毒疗法信任度和抗逆转录病毒疗法需求中等偏低;"有冲突"(13%),TasP 信仰、提供者信任度和抗逆转录病毒疗法需求高,但自我效能感、抗逆转录病毒疗法信任度和社会支持中等偏低;"有动力"(81%),所有指标均高。相对于 "有动机","有冲突 "与 "有动机 "特征成员的内化、实施和微攻击性污名化程度更高,与 "有冲突 "特征成员呈正相关。相对于 "积极型 "特征,"矛盾型 "特征更有可能出现抗逆转录病毒疗法不坚持、病毒载量不抑制和病毒载量不了解的情况。根据这些特征量身定制的个性化艾滋病护理可改善少数群体艾滋病病毒感染者坚持抗逆转录病毒疗法的情况及相关结果。
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来源期刊
Journal of Behavioral Medicine
Journal of Behavioral Medicine PSYCHOLOGY, CLINICAL-
CiteScore
5.70
自引率
3.20%
发文量
112
期刊介绍: The Journal of Behavioral Medicine is a broadly conceived interdisciplinary publication devoted to furthering understanding of physical health and illness through the knowledge, methods, and techniques of behavioral science. A significant function of the journal is the application of this knowledge to prevention, treatment, and rehabilitation and to the promotion of health at the individual, community, and population levels.The content of the journal spans all areas of basic and applied behavioral medicine research, conducted in and informed by all related disciplines including but not limited to: psychology, medicine, the public health sciences, sociology, anthropology, health economics, nursing, and biostatistics. Topics welcomed include but are not limited to: prevention of disease and health promotion; the effects of psychological stress on physical and psychological functioning; sociocultural influences on health and illness; adherence to medical regimens; the study of health related behaviors including tobacco use, substance use, sexual behavior, physical activity, and obesity; health services research; and behavioral factors in the prevention and treatment of somatic disorders.  Reports of interdisciplinary approaches to research are particularly welcomed.
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