Abstract
Despite advances in HIV antiretroviral medications, some patients do not achieve adequate medication adherence or suppressed viral load. The aim of this study was to identify the relationship between factors of impulsivity and medication non-adherence. It was hypothesized that impulsivity would have a direct association with non-adherence, after accounting for other known correlates. Participants included 322 HIV positive individuals (M age = 49, 56% male, 64% Black/African American). Impulsivity was measured using the Barratt Impulsiveness Scale-Brief (BIS-Brief). Factor analysis was conducted to determine if BIS-Brief resulted in a unidimensional or multi-factor solution. Results were suggestive of a two-factor solution: behavioral impulsivity and non-planning impulsivity. Structural equation modeling found non-planning impulsivity was associated with non-adherence (β = 0.18, p = 0.016), while no significant association was observed for behavioral impulsiveness. Results suggest that strategies related to planning for future consequences may be beneficial for impulsive persons with medication adherence difficulties.
Resumen
A pesar de los avances en los medicamentos antirretrovirales contra el VIH, algunos no logran una adherencia adecuada a los medicamentos ni suprimen la carga viral. El objetivo de este estudio fue identificar la relación entre los factores de impulsividad y la adherencia a la medicación. Se formuló la hipótesis de que la impulsividad tendría una asociación directa con la falta de adherencia, después de tener en cuenta otros correlativos conocidos. Los participantes incluyeron 322 individuos VIH positivos (M edad = 49, 56% hombres, 64% Black/African American). La impulsividad se midió usando la Barratt Impulsiveness Scale-Brief (BIS-Brief). El análisis factorial se realizó para determinar si BIS-Brief dio como resultado una solución unidimensional o multifactorial. Los resultados sugirieron una solución de dos factores: impulsividad conductual e impulsividad no planificada. El modelado de ecuaciones estructurales encontró que la impulsividad no planificada se asoció negativamente con la adherencia (β = 0.18, p = 0.02), mientras que no se observó una asociación significativa para la impulsividad conductual. Los resultados sugieren que las estrategias relacionadas con la planificación de las consecuencias futuras pueden ser beneficiosas para las personas impulsivas con dificultades de adherencia.
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References
Centers for Disease Control and Prevention. HIV incidence: estimated annual infections in the U.S., 2008–2014. CDC Fact Sheets. 2015.
Ray M, Logan R, Sterne J, et al. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010;24(1):123.
Kyser M, Buchacz K, Bush TJ, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011;23:601–11.
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.
Cook R, Zhou Z, Kelso-Chichetto N, et al. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract. 2017;12:22.
Beer L, Heffelfinger J, Frazier E, et al. Use of and adherence to antiretroviral therapy in a large US sample of HIV-infected adults in care, 2007-2008. Open AIDS J. 2012;6:213.
Centers for Disease Control and Prevention. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV Surveillance Supplemental Report, vol. 172012.
Chesney MA, Morin M, Sherr L. Adherence to HIV combination therapy. Soc Sci Med. 2000;50:1599–605.
Tucker JS, Burnam MA, Sherbourne CD, Kung F-Y, Gifford AL. Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003;114(7):573–80.
Nel A, Kagee A. The relationship between depression, anxiety and medication adherence among patients receiving antiretroviral treatment in South Africa. AIDS Care. 2013;25:948–55.
Nicholas PK, Willard S, Thompson C, et al. Engagement with care, substance use, and adherence to therapy in HIV/AIDS. AIDS Res Treat. 2014;2014:7.
Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001;158:1783–93.
Swann AC, Janicak PL, Calabrese JR, et al. Structure of mania: depressive, irritable, and psychotic clusters with different retrospectively-assessed course patterns of illness in randomized clinical trial participants. J Affect Disord. 2001;67:123–32.
Robbins TW, Gillan CM, Smith DG, de Wit S, Ersche KD. Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends Cogn Sci. 2012;16:81–91.
Acton GS. Measurement of impulsivity in a hierarchical model of personality traits: implications for substance use. Subst Use Misuse. 2003;38:67–83.
Oshri A, Tubman JG, Morgan-Lopez AA, Saavedra LM, Csizmadia A. Sexual sensation seeking, co-occurring sex and alcohol use, and sexual risk behavior among adolescents in treatment for substance use problems. Am J Addict. 2013;22:197–205.
Barratt ES. Impulsiveness subtraits: arousal and information processing. In: Spence JT, Itard CE, editors. Motivation, emotion, and personality. Amsterdam: Elsevier; 1985. p. 137–46.
Patton JH, Stanford MS. Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol. 1995;51:768–74.
Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: an update and review. Pers Individ Differ. 2009;47:385–95.
Belzeaux R, Boyer L, Mazzola-Pomietto P, et al. Adherence to medication is associated with non-planning impulsivity in euthymic bipolar disorder patients. J Affect Disord. 2015;184:60–6.
Steinberg L, Sharp C, Stanford MS, Tharp AT. New tricks for an old measure: the development of the Barratt Impulsiveness Scale-Brief (BIS-Brief). Psychol Assess. 2013;25:216.
Wilson IB, Lee Y, Michaud J, Fowler FJ, Rogers WH. Validation of a new three-item self-report measure for medication adherence. AIDS Behav. 2016;20:2700–8.
Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med. 2015;5:470–82.
Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.
Arbuckle JL. Amos 23.0 user’s guide. Chicago: IBM SPSS; 2014.
DeVillis RF. Scale development: theory and application. 2nd ed. Thousand Oaks, CA: Sage; 2003.
Hayes-Roth B, Hayes-Roth F. A cognitive model of planning. Cogn Sci. 1979;3:275–310.
Marazziti D, Consoli G, Picchetti M, Carlini M, Faravelli L. Cognitive impairment in major depression. Eur J Pharmacol. 2010;626:83–6.
Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97:2238–45.
Saddichha S, Schuetz C. Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Compr Psychiatry. 2014;55:1479–84.
Safren SA, Bedoya CA, O’Cleirigh C, et al. Treating depression and adherence (CBT-AD) in patients with HIV in care: a three-arm randomized controlled trial. Lancet HIV. 2016;3:e529.
Himelhoch S, Medoff D, Maxfield J, et al. Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS Behav. 2013;17:2756–64.
Magidson JF, Seitz-Brown C, Safren SA, Daughters SB. Implementing behavioral activation and life-steps for depression and HIV medication adherence in a community health center. Cogn Behav Pract. 2014;21:386–403.
Moitra E, Herbert JD, Forman EM. Acceptance-based behavior therapy to promote HIV medication adherence. AIDS Care. 2011;23:1660–7.
Baler RD, Volkow ND. Drug addiction: the neurobiology of disrupted self-control. Trends Mol Med. 2006;12:559–66.
Tang Y-Y, Posner MI, Rothbart MK, Volkow ND. Circuitry of self-control and its role in reducing addiction. Trends Cogn Sci. 2015;19:439–44.
Tang YY, Yang L, Leve LD, Harold GT. Improving executive function and its neurobiological mechanisms through a mindfulness-based intervention: advances within the field of developmental neuroscience. Child Dev Perspect. 2012;6:361–6.
Tang Y-Y, Posner MI. Attention training and attention state training. Trends Cogn Sci. 2009;13:222–7.
Funding
This research was supported by the Southern HIV and Alcohol Research Consortium (SHARC; U24AA022002; PI: Cook). Eugene M. Dunne, PhD received predoctoral support through the NIDA-funded University of Florida Substance Abuse Training Center in Public Health (T32DA035167; PI: Linda B. Cottler, PhD, MPH, FACE) and postdoctoral support through the NIMH-funded Adolescent/Young Adult Biobehavioral HIV Training Grant (T32MH078788; PI: Larry K. Brown, MD). Nicole Ennis, PhD received support from the National Institute of Drug Abuse under Grant #K23DA039769-01 (PI: Ennis). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank the Florida Department of Health HIV Surveillance Section for helping to provide viral load data to the Florida Cohort project.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Dunne, E.M., Cook, R.L. & Ennis, N. Non-planning Impulsivity But Not Behavioral Impulsivity is Associated with HIV Medication Non-adherence. AIDS Behav 23, 1297–1305 (2019). https://doi.org/10.1007/s10461-018-2278-z
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DOI: https://doi.org/10.1007/s10461-018-2278-z