Allison R. Webel

Ph.D. in Nursing

Medication adherence is the "Plus" in the global challenge to have 90% of HIV-infected individuals tested, 90% of those who are HIV positive treated, and 90% of those treated achieve an undetectable viral load. The latter indicates viral suppression, the goal for clinicians treating people living with HIV (PLWH). The comparative importance of different psychosocial scales in predicting the level of antiretroviral adherence, however, has been little studied. Using data from a cross-sectional study of medication adherence with an international convenience sample of 1811 PLWH, we categorized respondent medication adherence as None (0%), Low (1-60%), Moderate (61-94%), and High (95-100%) adherence based on self-report. The survey contained 13 psychosocial scales/indices, all of which were correlated with one another (p < 0.05 or less) and had differing degrees of association with the levels of adherence. Controlling for the influence of race, gender, education, and ability to pay for care, all scales/indices were associated with adherence, with the exception of Berger's perceived stigma scale. Using forward selection stepwise regression, we found that adherence self-efficacy, depression, stressful life events, and perceived stigma were significant predictors of medication adherence. Among the demographic variables entered into the model, nonwhite race was associated with double the odds of being in the None rather than in the High adherence category, suggesting these individuals may require additional support. In addition, asking about self-efficacy, depression, stigma, and stressful life events also will be beneficial in identifying patients requiring greater adherence support. This support is essential to medication adherence, the Plus to 90-90-90.

Background: People living with HIV (PLHIV) are at increased risk for developing cardiovascular disease (CVD). Cardiorespiratory fitness is the best indicator of CVD-related morbidity and mortality ...

Introduction: Sub-Saharan Africa (SSA) is disproportionately impacted by HIV and HIV-related atherosclerotic cardiovascular disease (ASCVD). Since physical activity may prevent ASCVD events, it is important to understand how physical activity and inactivity relate to ASCVD risk among men and women with and without HIV in SSA. Methods: One hundred people with HIV (PWH) and 100 people without HIV (PWOH) matched by age and sex were enrolled into this observational study in Kampala, Uganda. Physical activity was objectively measured by actigraphy for 7 days, including steps per day, light activity time, moderate-to-vigorous activity time and sedentary time. ASCVD risk was assessed using the pooled-cohort equations. Coronary artery disease was quantified by cardiac computed tomography angiography. Multivariable linear and logistic regression models were used to determine the relationship between physical activity, ASCVD risk, and subclinical coronary disease. Results: Median age was 57 years; 63% were female and median ASCVD risk score was 7.9%. All PWH were on antiretroviral therapy and 86% had undetectable HIV viral load. Physical activity patterns were similar by HIV status (all p>0.2). Compared to males, females took more steps per day ( p =0.001) and engaged in more light activity time ( p <0.001), but less moderate-to-vigorous activity time ( p <0.001). Sedentary time was similar by HIV status and sex (both p>0.8). After adjusting for moderate-to-vigorous activity time, sedentary time remained positively associated with ASCVD risk (standardized β=0.334, p <0.001). In stratified models, sedentary time was associated with ASCVD risk in females (β=0.258, p =0.028) but not males (p=0.194) and in PWOH (β=0.430, p=0.001) but not PWH (p=0.380). Sedentary time was associated with the presence of coronary artery disease plaque, even after adjustment for ASCVD risk score (adjusted OR= 1.039 per hour of sedentary time, p =0.018). Conclusions: Sedentary time is strongly associated with atherosclerotic cardiovascular disease risk in Uganda, particularly among females, but less so among PWH. Future studies should consider the influence of sex and HIV status while developing targeted strategies to improve physical activity and reduce sedentary time.

Introduction: With the advent of combination antiretroviral therapy, obesity is increasingly prevalent in people living with HIV (PLHIV). In particular, ectopic visceral fat may be associated with ...

Introduction: Rheumatic Heart Disease (RHD) disproportionately affects women of reproductive age, as it increases the risk of complications and death during pregnancy and childbirth. In sub-Saharan...