Low medication adherence associated with low intrinsic motivation: an observational study in rural Georgia HIV clinics Open Access

Rice, Marion (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/gh93h0038?locale=en


Background: Southern states have the highest prevalence of HIV in both urban and rural areas. Although geographic isolation, underfunded health and social support programs, high levels of poverty, and inadequate access to healthcare services are barriers to HIV treatment adherence in the rural South, individual-level factors challenge adherence as well. This study addressed how individual motivation among HIV-infected individuals living in the South affects antiretroviral treatment (ART) adherence, as new technologies may provide opportunities to access specific interventions that can improve motivation.

Objective: This cross-sectional study examined the relationship between sociodemographic and behavioral measures and baseline ART adherence (ART) among HIV-infected individuals living in rural Georgia and enrolled in the Music for Health Project.

Methods: We created a logistic regression model to determine which predictors are associated with participants who recently changed their ART regimen (non-adherent) versus those who were treatment naïve and newly starting an ART regimen (both adherent and non-adherent).

Results: Of 106 participants, 45% were enrolled as "regimen change" and considered less adherent. These participants reported lower ART adherence in the last 30 days than participants newly beginning ART (mean score 33.11 vs 30.74, p-value 0.0242). Most study participants were African American (75.5%), male (67%), unemployed (31.1%), and identified as homosexual or bisexual (60.4%). Regimen change participants were 8.5 years older (p value <0.0001), had attained higher levels of education (47.92% vs 19.30%, p value 0.0050), and had lived with HIV for 8.7 years longer than treatment naive participants (p-value <0.0001). Fewer treatment naive participants lived alone (5.17% vs 30.00%, p-value 0.0046). In multivariate logistic regression analysis adjusted for living alone, high external motivation (aOR: 1.89, 95% CI: 0.75, 4.78) was associated with ART non adherence, while internal motivation was inversely related to adherence (aOR: 0.86, 95% CI: 0.34, 2.21), although these associations were not statistically significant.

Conclusion: ART adherence may be influenced by internal and external motivation, and interventions to improve adherence should take into account ways to increase internal motivation in persons on ART.

Table of Contents




Characteristics of participants.7

Characteristics of participants by enrollment group.9

Bivariate analysis.9

Multivariate analysis.9




Table 1. Baseline ACASI instrument description and Chronbach Alpha Coefficient, Music for Health Project, Georgia, U.S., 2016 (N=106).14

Table 2. Characteristics of participants at baseline, Music for Health Project, Georgia, U.S., 2016 (N=106).16

Table 3. Characteristics of participants who newly starting ART regimen versus those changing ART regimen, Music for Health Project, Georgia, U.S., 2016 (N=106).18

Table 4. The association between internal motivation, external motivation and changing ART regimen, controlling for living alone, Music for Health Project, Georgia, U.S., 2016 (N=106).21


Figure 1. Adaptation of the Information-Motivation-Behavioral Skills Model for ART Adherence (11).22


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