Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV.

Journal Article (Journal Article)

Depression is a known risk factor for antiretroviral therapy (ART) non-adherence, but little is known about the mechanisms explaining this relationship. Identifying these mechanisms among people living with HIV (PLHIV) after release from prison is particularly important, as individuals during this critical period are at high risk for both depression and poor ART adherence. 347 PLHIV recently released from prison in North Carolina and Texas were included in analyses to assess mediation of the relationship between depressive symptoms at 2 weeks post-release and ART adherence (assessed by unannounced telephone pill counts) at weeks 9-21 post-release by the hypothesized explanatory mechanisms of alcohol use, drug use, adherence self-efficacy, and adherence motivation (measured at weeks 6 and 14 post-release). Indirect effects were estimated using structural equation models with maximum likelihood estimation and bootstrapped confidence intervals. On average, participants achieved 79% ART adherence. The indirect effect of depression on adherence through drug use was statistically significant; greater symptoms of depression were associated with greater drug use, which was in turn associated with lower adherence. Lower adherence self-efficacy was associated with depressive symptoms, but not with adherence. Depression screening and targeted mental health and substance use services for depressed individuals at risk of substance use constitute important steps to promote adherence to ART after prison release.

Full Text

Duke Authors

Cited Authors

  • Hill, LM; Golin, CE; Gottfredson, NC; Pence, BW; DiPrete, B; Carda-Auten, J; Groves, JS; Napravnik, S; Wohl, D; Knight, K; Flynn, PM

Published Date

  • August 2019

Published In

Volume / Issue

  • 23 / 8

Start / End Page

  • 2037 - 2047

PubMed ID

  • 30535731

Pubmed Central ID

  • PMC6555693

Electronic International Standard Serial Number (EISSN)

  • 1573-3254

Digital Object Identifier (DOI)

  • 10.1007/s10461-018-2355-3


  • eng

Conference Location

  • United States