(1115) Associations Between Stigma, Social Isolation, Treatment Self-regulation, and Positive and Negative Affect on Adherence Among Individuals with HIV and Substance Use Disorder

Objectives: This research study aimed to investigate the factors influencing medication adherence among a vulnerable population consisting of individuals living with HIV and co-occurring Substance Use Disorder (SUD). Utilizing a theory-informed approach, our objective was to identify the key constructs that impact medication adherence within this specific demographic, leveraging data collected through the Addiction Comprehensive Health Enhancement Support System (ACHESS) mobile health application.

Methods: We conducted a cross-sectional study of 208 participants using the A-CHESS mobile application from March to June 2019. Our dependent variable was Antiretroviral Therapy (ART) adherence, assessed via the Four-item Morisky Medication Adherence Scale (MMAS-4).

To explore factors affecting medication adherence, we conducted logistic regression analysis using several independent variables guided by Self-Determination Theory (SDT) constructs, which included stigma, education level, age, gender, loneliness, negative affect, Treatment Self-Regulation (TSR), and positive affect.

Results: Among the 208 participants, the majority were male (75%) and with a mean age of 46.34 years. Approximately 65.90% of the participants identified as Black. A significant proportion experienced challenges in disclosing their HIV status (56.73%), and 57.21% admitted to concealing their HIV status from others.
Stigma was significantly associated with medication adherence (adjusted odds ratio = 0.83, 95% CI [0.70, 0.99], p = 0.04). Higher levels of stigma were associated with a reduced odds of medication adherence. Education level was also significantly associated with medication adherence (adjusted odds ratio = 0.41, 95% CI [0.22, 0.76], p = 0.005). Participants with a college education were less likely to exhibit medication nonadherence compared to those with less than a college education. However, no significant associations were observed between medication adherence and other variables, including age, gender, loneliness, negative affect, TSR and positive affect.

Conclusions: These findings underscore the critical need for targeted interventions addressing stigma and educational disparities to improve medication adherence and overall health outcomes among people with HIV and comorbid SUD. Using mobile applications such as ACHESS, stigma can be further reduced by examining the types of stigma people with HIV and SUD experience to improve their adherence to ART.