1417. The Impact of Psychosocial Factors on ART Adherence is Mediated by Poverty in Older Adults Living With HIV


 
 
 Despite decades of work evaluating multiple interventions to improve ART adherence, viral load suppression in the U.S. remains far below Ending the HIV Epidemic goals. Previous research demonstrates that income and other factors, including social well-being (SWB), resilience, and exercise, are correlated with ART adherence. However, it is unclear how these factors interact with income to impact adherence in older adults living with HIV (OALWH).
 
 
 
 Self-reported outcome measures from the Aging with Dignity, Health, Optimism, and Community (ADHOC) cohort were collected from November 2017 to June 2019. Adherence was measured using the Brief Adherence Self-Report Questionnaire, depression using the Patient Health Questionnaire-2, SWB using the Functional Assessment of HIV Infection, and resilience using the Connor-Davidson Resilience Scale. Face-valid questions provided data on household income, race, sexual orientation, # of ART pills daily, and exercise. Linear regressions assessed the associations between these variables and adherence. Mediation analysis using bootstrapping assessed the significance of the mediation effects of income on these variables.
 
 
 
 For 1,039 ADHOC participants, average age was 59 years, 86% were male, 69% were White, and mean adherence was 96.2% (SD=11.2). In bivariate analyses, depression, SWB, exercise, resilience, White race, # ART pills daily, and sexual orientation were each significantly correlated with both ART adherence and income. Interestingly, depression, SWB, resilience, and exercise became non-significant predictors of adherence after adjusting for the effects of income. Mediation analysis with bootstrapping demonstrated significant causal mediation effects of income on depression and adherence (B=-0.14, 95% CI (-0.25 – -0.04)), SWB and adherence (B=0.03, 95% CI (0.01 – 0.05)), resilience and adherence (B=0.15, 95% CI (0.04 – 0.27)), and exercise and adherence (B=0.002, 95% CI (0.0007-0.003)).
 
 
 
 In OALWH, household income mediates the relationship between ART adherence and depression, SWB, resilience, and exercise. Therefore, interventions to improve adherence must address the causal role of income and focus on providing low-income patients with economic support to help lift them out of poverty.
 
 
 
 Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support Frank Spinelli, MD, Gilead Sciences: Employee|ViiV Healthcare: former employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds.
