Antiretroviral Adherence among Persons Living with HIV in the United States and India

The fifth decade of the human immunodeficiency virus (HIV) epidemic has brought about developments in HIV therapeutics with the first licensure and distribution of injectable combination antiretroviral therapy (ART), yet challenges in oral ART adherence continue to persist in groups vulnerable to HIV. Using data collected from two separate baseline surveys within a pilot study in India and a randomized controlled trial (RCT) in the United States, we assessed determinants of ART adherence in gay, bisexual, and other men who have sex with men (MSM) and sex workers (SW) living with HIV in India, and young Black MSM living with HIV in the United States. Additionally, we assessed the acceptability and effectiveness of the first licensed injectable ART among a clinical sample of people living with HIV (PLWH) seeking care at a large, urban HIV/ Acquired immunodeficiency syndrome (AIDS) clinic in Chicago. In a preliminary analysis in India, we found that low health literacy was associated with non-optimal ART adherence, yet engaging in sex work did not contribute to non-optimal ART adherence. Other factors such as religious obligations, employment, and having children were associated with non-optimal ART adherence. In the United States, we used the information-motivation-behavioral skills model of ART adherence and found treatment self-efficacy to mediate the association between motivation/social support and non-optimal ART adherence, yet knowledge was not associated with non-optimal ART adherence. Among the clinical sample in Chicago receiving injectable ART, patients reported high acceptability and effectiveness. Notably, this sample had a high proportion of Non-Hispanic Black and Hispanic individuals, women, and > 50 years old, better capturing those disproportionately impacted by HIV and often underrepresented in RCTs. Acceptability of injectable ART may suggest this form of treatment to be an acceptable alternative for those who struggle to adhere to daily oral ART regimens, like those disproportionately impacted by HIV in India and the United States. In addition, efforts to mitigate barriers of ART adherence, such as low health literacy and social support, are needed among these understudied groups.