The effects of markers for HIV disease progression, social network, barriers to care, depression, and substance abuse on medical appointment adherence of HIV-infected adults

The study was designed to test a causal model of theoretical relationships among markers for HIV disease progression, social network, barriers to care, depression, substance abuse, and medical appointment adherence among HIV-infected adults. The proposed causal model was derived and developed from Lazarus and Folkman's theory of stress, appraisal, and coping. The knowledge gained from this study may yield critical information with respect to determining how a health care provider or researcher can develop specific behavioral interventions for the improvement of medical appointment adherence among HIV-infected adults living in the Southeastern United States.;The correlational study was a secondary analysis of data from the UAB Center for AIDS Research 1917 HIV Clinic Cohort Database. Three hundred and thirty eight clients entering care during the period from 1 July 2009 through 30 June 2011 who met specific criteria were included in the secondary analysis. The analysis included data collected during an initial baseline measurement at entry into care and the pattern of adherence to medical appointments was observed over a 12-month period.;Structural equation modeling was conducted to test the proposed model using LISREL 8.4 software. The following proposed relationships among the causal model variable were found to be consistent with the data: (1) distance to treatment facility and depression were found to have direct positive effects on adherence to medical appointments; (2) substance abuse was found to have a direct negative effect on adherence; (3) social network had a direct positive effect on substance abuse; and (4) HIV disease progression had a direct negative effect on substance abuse.;The fully trimmed model provided a good fit to the observed data, with a χ2 (21, N = 338) = 22.31, p =.38; GFI = 0.99; RMSEA = 0.03, and CFI = 0.99. Thus the null hypothesis of no differences was supported for the trimmed model. However, the model only accounted for eight percent of the variance in adherence to medical appointments (R2 = 0.08). Longitudinal study of the relationships among causal model variable is recommended for deeper understanding of the pattern of HIV medical appointments adherence over time.