Environmental Influences on HIV Medication Adherence

The Role of Neighborhood Disorder

Bibliographic Data

ID11030679
AuthorsHilary L Surratt (0000-0003-4027-7840, Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston.), Steven P Kurtz (0000-0002-4243-8129, Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston.), Maria A Levi-Minzi (Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston.), Maria A Levi‐Minzi (Nova Southeastern University), Minxing Chen (0000-0002-1247-8752, Hilary L. Surratt, Steven P. Kurtz, and Maria A. Levi-Minzi are with the Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, FL. Minxing Chen is with the Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston.)
Year2015
Volume105
Issue8
Pages1660-1666
Publication date2015-08-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAmerican Journal of Public Health (JOURNAL)
Journal identifiersISSN: 0090-0036 • E-ISSN: 1541-0048
PublisherAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2015.302612
PMID26066966
PMCIDPMC4498986
OpenAlexW2135866936
LanguageEN
Citations received21
References cited46

Objectives. We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. Methods. Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. Results. The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. Conclusions. Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services

Disadvantaged · Environmental health · Family medicine · Housing First · Human immunodeficiency virus (HIV) · Mediation · Medication adherence · Mental health · Psychiatry · Vulnerability (computing) · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Homelessness and Social Issues · Medicine

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