Mediators of Antiretroviral Medication Adherence: A Multisite International Study
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Abstract
The purpose of this study was to investigate the effects of stressful life events (SLE on medication adherence (3 day, 30 day) as mediated by sense of coherence (SOC), selfcompassion (SCS), and engagement with the health care provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand and the U.S. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance (MANOVA), analysis of variance (ANOVA) with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC and eHCP with adherence (3 day, 30 day) indicated these combined variables were related to adherence whether 3 day or 30 day to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the U.S (p= <.001), Canada (p= .006), and Namibia (p= .019). The combined independent variables were significant predictors of adherence past 30 days only in the U.S. and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest while enriched by a sample obtained from international sites, may not have the same relationships in each country.
