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This version was published on April 1, 2008
Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 2, 74-81 (2008)
DOI: 10.1177/1545109708315326
© 2008 SAGE Publications

Psychosocial Impact of Poverty on Antiretroviral Nonadherence Among HIV-TB Coinfected Patients in Lima, Peru

Sonya Shin, MD, MPH

Brigham and Women's Hospital, Division of Social Medicine and Health Inequalities, FXB Building, 7th Floor, 651 Huntington Ave, sshin{at}partners.org

Maribel Muñoz, RN, MPH

Socios en Salud, Lima Peru

Betty Espiritu, RN

Socios en Salud, Lima Peru

Jhon Zeladita, RN

Socios en Salud, Lima Peru

Eduardo Sanchez, MD

Hospital Hipolito Hunanue, Lima, Peru

Miriam Callacna, RN

Hospital Hipolito Hunanue, Lima, Peru

Christian Rojas, MD

Hospital Hipolito Hunanue, Lima, Peru

Jorge Arevalo, MD

Hospital Dos de Mayo, Lima, Peru

Ying Wu, MD

Yale University, New Haven, Connecticutt

Adolfo Caldas, MSW

Brigham and Women's Hospital, Division of Social Medicine and Health Inequalities, FXB Building, 7th Floor, 651 Huntington Ave

Jose Luis Sebastian, MD

Ministry of Health, Lima, Peru

Objective. Tuberculosis and HIV coinfection poses unique clinical and psychosocial complexities that can impact nonadherence to highly active antiretroviral treatment (HAART). Methods. This was a prospective case series to identify risk factors for HAART nonadherence among 43 patients with HIV and tuberculosis (TB) in Lima, Peru. Nonadherence was defined by patient self-report. Results. The median initial CD4 and HIV viral load were 63 and 159,000, respectively. Patients had received a median of 6.1 months of ART. Univariable analysis found low social support, substance use, and depression to be associated with nonadherence. In multivariable analysis, low social support was associated with nonadherence. Conclusions. In the authors' urban cohort of HIV-TB coinfected individuals in Lima, Peru, substance use, depression, and lack of social support were key barriers to adherence. These findings suggest that adherence interventions may be unsuccessful unless they target the underlying psychosocial challenges faced by patients living with TB and AIDS.

Key Words: HIV • tuberculosis • adherence • poverty • social support


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