Date of Award

2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Abstract

Adherence to antiretroviral therapy is crucial for thwarting disease progression and reducing secondary transmission, yet HIV+ youth struggle with adherence. The highest rates of new HIV infections occur in young African American men (YAAM), thus understanding reasons for non-adherence in this group is critical. Reasons for non-adherence can be complex and multifactorial, and innovative methods of exploration are needed for advancing prevention and treatment efforts. A sample of 387 HIV+ YAAM who reported currently taking HIV medications were selected from a cross-sectional assessment of 2,226 HIV+ youth from sites within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2009-2012 (12-24 years-old, Median = 22.00, SD 2.06). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Seventy-two theoretically relevant predictors of adherence underwent Optimal Data Analysis (ODA) to construct a classification tree which hierarchically maximizes the classification accuracy of 100% adherence. Sixty-two percent reported 100% adherence (no missing doses) over the past seven days. Frequency of cannabis use was the strongest predictor of adherence, yielding moderate effect strength sensitivity, ESS = 27.1, p < 0.00. Among participants with infrequent cannabis use, 72% demonstrated full adherence, while only 45% of participants who used cannabis (monthly or more) demonstrated full adherence. Classification tree analysis (CTA) correctly classified 82.35% of those who were adherent and 64.85% of those who were non-adherent. The final CTA adherence model was strong (ESS = 49.12) identifying four pathways towards adherence and five pathways toward non-adherence. Participants most likely to be adherent were those less likely to have substance abuse issues and reported low levels of psychiatric distress (92.59% were adherent). This research demonstrates the impact of substance use and mental health on adherence among YAAM. Moreover, this analysis identifies complex and multiple profiles of adherence among HIV+ YAAM and suggests that targeted interventions may be most prudent.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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