Social Determinants of ART Adherence among Black Adults with HIV

Background: Black people with HIV (PWH) show poorer rates of antiretroviral therapy (ART) adherence compared to other racial/ethnic groups in the United States. Social determinants of health (SDOH) may influence ART adherence, and disparities in SDOH are known to disproportionately impact Black communities. The iC-CHANGE study evaluated the efficacy of a personalized, culturally adapted, text messaging intervention to improve ART adherence among Black PWH and incorporated self-report measures of ART adherence at study visits. This analysis sought to examine the relationship between SDOH and longitudinal ART adherence measures. Methods: Participants (90 Black PWH) were sent text messages through a two-way, fully automated text-messaging intervention, and attended in person study visits (12-week intervals). Measures of ART adherence included a visual analog scale, 3-item quantitative questionnaire, and text message responses. The relationship between SDOH and ART adherence measures were evaluated using linear and logistic mixed effects regression models. Results: Majority of the participants (n=90) were male (82.0%) and mean (SD) age was 46.5 (11.7) years at baseline. Housing stability was significantly associated with ART adherence, such that individuals without stable housing had lower scores on the 3-item self-report adherence scale (β = -4.04, p = .001), the visual analog adherence scale (β = -4.15, p = .02), and text message responses (β = -.03, p =.02) compared to individuals with stable housing. Older age was also associated with higher adherence on the visual analog scale (β = 0.003, p = .008), but lower adherence in daily text message responses (β = -0.06, p = .03). Health literacy also showed a positive association with ART adherence as measures by text message responses (β = 0.03, p < .02). Conclusion: These findings highlight the need for targeted interventions addressing housing stability and health literacy to improve ART adherence among Black individuals with HIV. Integrating these factors with clinical care may significantly enhance treatment outcomes and contribute to health equity.