Examining HIV Treatment Adherence During Early Disease

Specific Aims

Aim 1: Determine the level, patterns, and correlates of objectively measured ART adherence in early and advanced-stage disease, among pregnant and non-pregnant individuals, to determine the need and nature of interventions to support early ART adherence in Uganda and South Africa. Outcomes include: i) average adherence, ii) incidence of any 28-day period with <80% adherence, iii) number of ART interruptions >72 hours (which could lead to loss of viral suppression), and iv) detectable HIV RNA >400 copies/Ml at 6 and 12 months. Guided by prior work and the Theory of Vulnerable Populations, we hypothesize that incomplete adherence will be associated with a) early-stage, asymptomatic disease, b) pregnancy and postpartum periods, and c) multiple social and economic factors. Individuals with CD4 200-350 will not be studied in order to most efficiently identify differences at the extremes of early and advanced disease.

Aim 2: Given the known importance of social networks and social support for adherence in advanced-stage disease in some RLS, we will determine the extent to which social network cohesion, HIV serostatus disclosure within the network, and receipt of social support explain differential ART adherence in early and advanced-stage disease. We hypothesize that: i) compared to people with advanced-stage disease, people with early-stage disease will have less cohesive social networks, disclose their seropositivity to fewer network members, and receive less social support; ii) social network cohesion, serostatus disclosure, and social support will be associated with greater ART adherence; and iii) these associations will explain a significant portion of differential ART adherence in early versus advanced-stage disease. Additionally, although these factors have been well established previously in Uganda, prospective data is needed to account for secular trends related to treatment expansion and comparable data are needed from South Africa.

Aim 3: We will use qualitative methods to identify, describe and explain influences on ART adherence in early-stage disease to guide intervention development. In-depth understanding of influences on ART adherence among individuals with early-stage HIV disease will inform the focus of any needed ART adherence interventions for this population. We will conduct in-depth, adherence-focused qualitative interviews with (a) 50 HIV+ men and non-pregnant women, and (b) 50 HIV+ pregnant women, who initiate ART with early-stage disease. Interviews with pregnant women may be post-partum by the time of the interview. Equal numbers of individuals in these two groups will be drawn from the Uganda and South Africa sites.

Study Procedures