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Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa

a prospective cohort study

Katz, Ingrid T.a,b,c,d; Bogart, Laura M.e; Dietrich, Janan J.f; Leslie, Hannah H.g; Iyer, Hari S.g; Leone, Dominicka,h; Magidson, Jessica F.i; Earnshaw, Valerie A.j; Courtney, Ingridk; Tshabalala, Guguf; Fitzmaurice, Garrett M.a,b,l,m; Orrell, Catherinek; Gray, Glendaf,n; Bangsberg, David R.o

doi: 10.1097/QAD.0000000000002175
Supplement Articles

Objective: Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90–90–90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention.

Design: Prospective cohort study.

Methods: From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors.

Results: Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89–0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00–1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65–0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02–1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00–1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77–0.92), compared with those who initiated ART but did not achieve plasma RNA suppression.

Conclusion: Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.

aDepartment of Medicine, Brigham and Women's Hospital

bHarvard Medical School

cMassachusetts General Hospital Center for Global Health, Boston

dHarvard Global Health Institute, Cambridge, Massachusetts

eRAND Corporation, Santa Monica, California, USA

fPerinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

gHarvard T.H. Chan School of Public Health

hBrigham and Women's Hospital, Channing Division of Network Medicine, Boston, Massachusetts

iDepartment of Psychology, University of Maryland, College Park, Maryland

jDepartment of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA

kDesmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa

lDepartment of Biostatistics, Harvard School of Public Health, Boston

mLaboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, USA

nOffice of the President, South African Medical Research Council, Western Cape, South Africa

oOregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA.

Correspondence to Ingrid T. Katz, Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor BWH, Boston, MA 02120, USA. Tel: +1 617 525 8194; e-mail:

Received 26 March, 2018

Revised 5 December, 2018

Accepted 6 December, 2018

Copyright © 2019 Wolters Kluwer Health, Inc.