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HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients

Shrestha, Roman, MPH, PhD*,†; Altice, Frederick L., MD†,‡,§; Copenhaver, Michael M., PhD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1, 2019 - Volume 80 - Issue 2 - p 166–173
doi: 10.1097/QAI.0000000000001891
Prevention Research

Background: Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART); yet, no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment, including explanatory pathways using mediation analysis.

Setting: Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART.

Methods: Participants were assessed using an audio computer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates and PROCESS macro to test the explanatory pathway (ie, mediational effect) for optimal ART adherence.

Results: Among 121 participants, almost 40% reported suboptimal adherence to ART. Optimal ART adherence was significantly associated with being virally suppressed [adjusted odds ratio (aOR) = 6.470, P = 0.038], higher motivation to adhere to ART (aOR = 1.171, P = 0.011), and lower anticipated HIV-related stigma (aOR = 0.384, P = 0.015). Furthermore, results revealed an indirect effect of motivation on the relationship between HIV stigma and ART adherence (effect = −0.121, P = 0.043), thus supporting the mediation effect.

Conclusions: Our findings underscore the complexities surrounding ART adherence, even in patients on methadone maintenance treatment. These findings provide insights on how to more effectively intervene to optimize HIV treatment outcomes, including HIV treatment-as-prevention initiatives, in methadone-maintained patients.

*Department of Allied Health Sciences, University of Connecticut, Storrs, CT;

Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT;

Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT; and

§Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT.

Correspondence to: Roman Shrestha, MPH, PhD, 358 Mansfield Road, Unit 1101, Storrs, CT 06269-1101 (e-mail:

Supported by grants from the National Institute on Drug Abuse for research (R01 DA032290 to M.M.C.) and for career development (K24 DA017072 to F.L.A.; K02 DA033139 to M.M.C.).

The authors have no conflicts of interest to disclose.

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Received May 10, 2018

Accepted October 03, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.