Mediators of antiretroviral adherence: A multisite international study

I. B. Corless, A. J. Guarino, P. K. Nicholas, L. Tyer-Viola, K. Kirksey, J. Brion, C. Dawson Rose, L. S. Eller, M. Rivero-Mendez, J. Kemppainen, K. Nokes, E. Sefcik, J. Voss, D. Wantland, M. O. Johnson, J. C. Phillips, A. Webel, S. Iipinge, C. Portillo, W. T. ChenM. Maryland, M. J. Hamilton, P. Reid, D. Hickey, William Holzemer, K. M. Sullivan

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Original languageEnglish (US)
Pages (from-to)364-377
Number of pages14
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number3
StatePublished - Mar 1 2013

All Science Journal Classification (ASJC) codes

  • Social Psychology
  • Health(social science)
  • Public Health, Environmental and Occupational Health


  • adherence
  • engagement with the provider
  • self compassion
  • sense of coherence
  • stressful life events

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