Vulnerabilities and Resilience Processes in Adherence to Antiretroviral Therapy

Oliveira, Patrícia Paiva Carvalho de; Seidl, Eliane Maria Fleury; Scorsolini-Comin, Fabio

doi:10.1590/1982-4327e3529

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Psychology of Health • Paidéia (Ribeirão Preto) 35 • 2025 • https://doi.org/10.1590/1982-4327e3529 linkcopy

Vulnerabilities and Resilience Processes in Adherence to Antiretroviral Therapy

Vulnerabilidades e Processos de Resiliência na Adesão à Terapia Antirretroviral

Vulnerabilidades y Processos de Resiliencia en la Adherencia a la Terapia Antirretroviral

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Antiretroviral Therapy has reduced HIV morbidity and mortality. However, its benefits depend on adherence to treatment. The objective was to investigate the factors associated with adherence to antiretroviral medications by people living with HIV. The study was conducted with 237 adults, including adults and the elderly, using: Characterization questionnaire; Depression, Anxiety and Stress Scale; Resilience Assessment Scale; Duke Religiosity Index; Spirituality Self Rating Scale, and Questionnaire to assess adherence to antiretroviral treatment. Descriptive and inferential statistical analyses were performed. Of the participants, 72.6% were considered adherent. Symptoms of anxiety, increased frequency of alcohol consumption, and illicit drug use increased the odds of non-adherence, while resilience had a positive impact on adherence. The findings highlighted the impact of mental health on adherence and can guide the design of interventions that more effectively consider this dimension in the care of this group.

Keywords:
HIV; treatment adherence; antiretroviral therapy; health vulnerability; resilience

Variables	N	%
a. Demographic and socioeconomic
Gender
Cisgender Man	115	48.5
Cisgender Woman	112	47.3
Transgender Woman	10	4.2
Age
18 to 24 years old	6	2.5
25 to 29 years old	15	6.3
30 to 49 years old	112	47.3
50 to 60 years old	71	30.0
Equal to or greater than 60 years old	33	13.9
Color
Brown	84	35.2
Black	75	31.6
White	78	32.9
Education level
None	9	3.8
Incomplete elementary education	111	46.8
Complete elementary education	38	16.0
Incomplete high school education	15	6.3
Complete high school education	44	18.6
Incomplete higher education	8	3.4
Complete higher education	12	5.1
Family income
No income	4	1.7
Up to R$522	8	3.4
From R$522 to R$2089	147	62
From R$ 2089 to R$ 4177	61	25.8
Above R$ 4177	17	7.2
Religious or spiritual belief
Yes	233	98.3
No	4	1.7
b. Clinical aspects
Time of knowledge of HIV diagnosis
Up to 1 year	11	4.6
1 to 5 years	41	17.3
5 to 10 years	57	24.1
10 to 20 years	83	35.0
Over 20 years	45	19.0
Time of ART prescription
6 months to 1 year	12	5.1
1 to 5 years	48	20.3
5 to 10 years	51	21.5
Over 10 years	126	53.2
CD4
Less than 200 cells/mm³	23	9.7
Between 201 and 350 cells/mm³	29	12.2
Between 351 and 500 cells/mm³	43	18.1
Above 500 cells/mm³	142	59.9
Viral load
Undetectable	195	82.3
Fewer than 1,000 copies	14	5.9
Greater than 1,000 copies	28	11.8
Adherence to ART
Insufficient adherence	65	27.4
Adequate and strict adherence	172	72.6

Variable	N	%
Symptoms of Depression
Normal	77	32.5
Mild and moderate	83	35.1
Severe and extremely severe	77	32.5
Anxiety symptoms
Normal	130	51.7
Mild and moderate	35	14.8
Severe and extremely severe	71	30.1
Symptoms of stress
Normal	122	51.7
Mild and moderate	29	12.3
Severe and extremely severe	85	36.1

Scales	Average	Standard Deviation	Minimum	Maximum
Resilience Assessment Scale (RAS)
Spirituality	3.59	0.74	0.0	4.0
Persistence in the face of difficulties	3.53	0.80	0.0	4.0
Positive acceptance of change	3.48	0.68	0.0	4.0
Resignation	2.54	0.78	0.6	4.0
Personal Competence	2.47	1.08	0.0	4.0
Resilience (total score)	3.12	0.61	0.39	4.0
Religiosity Index (DUREL)
Organizational Religiosity (OR)	3.22	1.97	1.0	6.0
Non-Organizational Religiosity (RNO)	4.43	1.66	1.0	6.0
Intrinsic Religiosity (IR)	9.99	3.83	3.0	15.0
Spirituality Self Ranting Scale - SRSS (total score)	22.74	5.86	6.0	30.0

Variable	Exp(B)	CI 95%	p-value
Frequency of alcohol consumption	0.48	0.29-0.78	.049
Use of illicit drugs	0.03	0.00-0.98	.049
Presence of anxiety symptoms	0.38	0.15-0.90	.029
The resilience factor of personal competence	1.57	1.07-2.30	.019

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Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 , Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[TFN1] Note. Exp(B) (odds ratio); CI (Confidence interval); p < .05